LOCAL 92109 LLC NPI 1639677768

NPI Information

NPI: 1639677768
Provider Name: LOCAL 92109 LLC

Doing Business As: BOARDWALK RECOVERY CENTER

Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

Address:
1940 GARNET AVE STE 120
SAN DIEGO, CA
ZIP 92109
Phone: (619) 206-0081
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LOCAL 92109 LLC is a rehabilitation and substance use disorder clinic center in San Diego, CA. LOCAL 92109 LLC NPI is 1639677768. The provider is registered as an organization entity type.
The provider Is Doing Business As Boardwalk Recovery Center.

The provider's business location address is:

1940 GARNET AVE STE 120
SAN DIEGO, CA
ZIP 92109
Phone: (619) 206-0081

The provider's authorized official is Amanda Tamai .
The authorized official title is Executive Assistant and has the following contact phone number (619) 206-0081.

The CLIA number assigned to this NPI record is 05D2153187 - comp. outpatient rehab facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/23/2018 and was last updated on 8/15/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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