Provider Demographics
NPI:1437872645
Name:SCRC DANA POINT LLC
Entity type:Organization
Organization Name:SCRC DANA POINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-987-8078
Mailing Address - Street 1:34249 CAMINO CAPISTRANO # 101
Mailing Address - Street 2:
Mailing Address - City:CAPO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34249 CAMINO CAPISTRANO # 201
Practice Address - Street 2:
Practice Address - City:CAPO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624-1156
Practice Address - Country:US
Practice Address - Phone:949-359-5669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health