Provider Demographics
NPI:1871097311
Name:CHELSEA BY THE SEA
Entity type:Organization
Organization Name:CHELSEA BY THE SEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-356-2664
Mailing Address - Street 1:10211 KUKUI DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2518
Mailing Address - Country:US
Mailing Address - Phone:714-356-2664
Mailing Address - Fax:
Practice Address - Street 1:10211 KUKUI DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2518
Practice Address - Country:US
Practice Address - Phone:714-356-2664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TA0700X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty