Provider Demographics
NPI:1942018445
Name:TRUST SOCAL LLC
Entity type:Organization
Organization Name:TRUST SOCAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:AVDEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-412-4477
Mailing Address - Street 1:16537 ELM CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2214
Mailing Address - Country:US
Mailing Address - Phone:949-280-8360
Mailing Address - Fax:
Practice Address - Street 1:16537 ELM CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2214
Practice Address - Country:US
Practice Address - Phone:949-280-8360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder