Provider Demographics
NPI:1932929866
Name:TRUE NORTH DETOX LLC
Entity type:Organization
Organization Name:TRUE NORTH DETOX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUCHAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-417-7628
Mailing Address - Street 1:27525 PUERTA REAL STE 300-316
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6379
Mailing Address - Country:US
Mailing Address - Phone:714-417-7628
Mailing Address - Fax:
Practice Address - Street 1:3820 EL DORADO HILLS BLVD
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4580
Practice Address - Country:US
Practice Address - Phone:844-244-7837
Practice Address - Fax:559-793-7258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUE NORTH DETOX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-15
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility