Provider Demographics
NPI:1982410072
Name:INTERVENTION 911
Entity type:Organization
Organization Name:INTERVENTION 911
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-701-1959
Mailing Address - Street 1:33171 PASEO CERVEZA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-4824
Mailing Address - Country:US
Mailing Address - Phone:949-701-1959
Mailing Address - Fax:949-258-5510
Practice Address - Street 1:502 N CERRITOS DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6228
Practice Address - Country:US
Practice Address - Phone:949-701-1959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERVENTION 911
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility