Provider Demographics
NPI:1023403037
Name:FAITH BY THE SEA, INC.
Entity type:Organization
Organization Name:FAITH BY THE SEA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZONA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:949-542-8480
Mailing Address - Street 1:26895 ALISO CREEK RD
Mailing Address - Street 2:SUITE B-773
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5301
Mailing Address - Country:US
Mailing Address - Phone:949-542-8480
Mailing Address - Fax:949-429-3698
Practice Address - Street 1:27129 CALLE ARROYO
Practice Address - Street 2:SUITE 1821
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2764
Practice Address - Country:US
Practice Address - Phone:949-542-8480
Practice Address - Fax:949-429-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300309AP261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder