Provider Demographics
NPI:1174137467
Name:12 NORTH LLC
Entity type:Organization
Organization Name:12 NORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLMASOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-413-7554
Mailing Address - Street 1:23696 BIRTCHER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1769
Mailing Address - Country:US
Mailing Address - Phone:888-830-8374
Mailing Address - Fax:949-215-6650
Practice Address - Street 1:23696 BIRTCHER DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1769
Practice Address - Country:US
Practice Address - Phone:888-830-8374
Practice Address - Fax:949-215-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility