Crescent Moon Recovery, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

CRESCENT MOON RECOVERY, LLC

Practice address

11770 Warner Ave Ste 207
Fountain Valley, CA 92708-2661

Phone

(714) 464-8474

Fax

(714) 948-8883

NPI assigned

Apr 7, 2021

Last updated

May 20, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

CRESCENT MOON RECOVERY, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Adam Wade, MDNPI 1760914329

Title

Ceo

Phone

(661) 706-8898

Specialties & licenses 3

Addresses

Tax ID family

Crescent Moon Recovery LLC3 organizations share this tax ID, including this one

Part of

Crescent Moon Recovery LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Crescent Moon Recovery, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Huntington Beach, CA
  • NPI 1083200307
  NPD tax ID
• Crescent Moon Recovery, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Huntington Beach, CA
  • NPI 1497414379
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adam Curran Wade

  • Student in an Organized Health Care Education/Training Program
  • Orange, CA
  • NPI 1760914329
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621468800000",
    "number": "1992384663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11770 WARNER AVE STE 207",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927082661",
            "telephone_number": "714-464-8474",
            "fax_number": "714-948-8883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11770 WARNER AVE STE 207",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927082661",
            "telephone_number": "714-464-8474",
            "fax_number": "714-948-8883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT MOON RECOVERY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRESCENT MOON RECOVERY, LLC",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-706-8898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coury & Buehler Physical Therapy, Inc. (Coury & Buehler Physical Therapy - Fountain Valley)
• Deborah Renee Cox, SLPA
• Brian C Coyne, M.D.
• Jessica Anne Craig, D.P.T
• Creative Counseling Center of Orange County
• Charee Nicole Crisci
• Bryar Crisfield, SLP
• Mark Andrew Cromer, C.P.O.
• Maria Alexa Crosby, PT
• Adamaris Cruz

• Substance Use Disorder Rehabilitation Clinic/Center in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.