OrganizationActive
Pacific Coast Detox LLC
NPI 1063375129 · Substance Abuse Rehabilitation Facility · San Clemente, CA
Provider details
- NPI number
- 1063375129
- Entity type
- Organization
- Primary specialty
- Substance Abuse Rehabilitation FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Matthew Lee, Admin(619) 987-8078
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Established profile(53/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
184 Avenida La Cuesta
San Clemente, CA 92672-3142
Phone: (949) 359-5669
Street-level locationGet directions
Mailing address
21263 Doubtful Canyon Dr
Cypress, TX 77433-8470
Registry dates
- Enumerated
- 2025-12-05
- Last updated
- 2026-01-12
- Certified
- 2026-01-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.