Provider Demographics
NPI:1588087647
Name:COMPLETE RESURGENCY LLC
Entity type:Organization
Organization Name:COMPLETE RESURGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:HAMBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-315-3315
Mailing Address - Street 1:31957 VIRGINIA WAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6822
Mailing Address - Country:US
Mailing Address - Phone:312-315-3315
Mailing Address - Fax:
Practice Address - Street 1:31957 VIRGINIA WAY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6822
Practice Address - Country:US
Practice Address - Phone:949-837-2751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility