NPI: 1356915821
Provider Name: 417 NORTH COUNTY LLC
Doing Business As: 417 RECOVERY
Classification: Substance Abuse Rehabilitation Facility - 3245S0500X
Entity Type: Organization
Specialization: Substance Abuse Treatment, Children
CLIA Number: 05D2292570
Address:
1595 GRAND AVE
SAN MARCOS, CA
ZIP 92078
Phone: (760) 485-6563
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417 NORTH COUNTY LLC is a substance abuse treatment and children substance abuse rehabilitation facility in San Marcos, CA. The provider is a facility or distinct part of a facility for children that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. 417 NORTH COUNTY LLC NPI is 1356915821. The provider is registered as an organization entity type.
The provider Is Doing Business As 417 Recovery.
The provider's business location address is:
1595 GRAND AVE
SAN MARCOS, CA
ZIP 92078-450
Phone: (760) 485-6563
The provider's authorized official is Stevie Michelle Kuhn .
The authorized official title is Owner/cfo and has the following contact phone number (760) 485-6563.
The CLIA number assigned to this NPI record is 05D2292570 - ancillary testing site in health care center with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 5/18/2021 and was last updated on 12/6/2023.