Provider Demographics
NPI:1396151031
Name:WEST COAST MENS LLC
Entity type:Organization
Organization Name:WEST COAST MENS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIRTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-580-3549
Mailing Address - Street 1:516 S THE STRAND
Mailing Address - Street 2:UNIT B
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2916
Mailing Address - Country:US
Mailing Address - Phone:760-231-5394
Mailing Address - Fax:855-927-2687
Practice Address - Street 1:516 S THE STRAND
Practice Address - Street 2:UNIT B
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2916
Practice Address - Country:US
Practice Address - Phone:760-231-5394
Practice Address - Fax:855-927-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility