Provider Demographics
NPI:1942714100
Name:BEACHSIDE RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:BEACHSIDE RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-756-2301
Mailing Address - Street 1:10231 BRIER LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1518
Mailing Address - Country:US
Mailing Address - Phone:626-756-2301
Mailing Address - Fax:858-357-8689
Practice Address - Street 1:10231 BRIER LN
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1518
Practice Address - Country:US
Practice Address - Phone:626-756-2301
Practice Address - Fax:858-357-8689
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEACHSIDE RECOVERY CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-27
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300315CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility