Provider Demographics
NPI:1063700433
Name:WEST COAST DETOX, INC.
Entity type:Organization
Organization Name:WEST COAST DETOX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:REINER
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-235-8258
Mailing Address - Street 1:6381 YALE CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2557
Mailing Address - Country:US
Mailing Address - Phone:866-448-2723
Mailing Address - Fax:866-703-9903
Practice Address - Street 1:6381 YALE CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2557
Practice Address - Country:US
Practice Address - Phone:866-448-2723
Practice Address - Fax:866-703-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300228AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility