Provider Demographics
NPI:1063860534
Name:LAGUNA TREATMENT HOSPITAL, LLC
Entity type:Organization
Organization Name:LAGUNA TREATMENT HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FACILITY EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARTZFAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-446-0090
Mailing Address - Street 1:500 WILSON PIKE CIR STE 360
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24552 PACIFIC PARK DR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656
Practice Address - Country:US
Practice Address - Phone:949-446-0090
Practice Address - Fax:949-315-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550003560283X00000X, 284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
No283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
591319OtherTHE JOINT COMMISSION