12 SOUTH RECOVERY
NPI 1154789766
Substance Abuse Rehabilitation Facility in Lake Forest, CA

Q: What is 12 South LLC's NPI number?

The NPI number for 12 South LLC is 1154789766. It was assigned to this organization in the NPPES registry on February 10, 2016. The provider is also known as 12 South Recovery.

Q: What is 12 South LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Q: When was this NPI record last updated?

The NPPES record for 12 South LLC was last updated on November 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 10, 2016CLIA 05D2150589 · Waiver

23712 BIRTCHER DRIVE, LAKE FOREST, CA 92630(888) 830-8374(949) 215-6650 Get Directions Write a Review

NPPES record last updated: November 2, 2022. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Nov 2, 2022, Jan 8, 2019, Feb 10, 2016 (3 updates tracked since 2016).

On this page

About 12 South Recovery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

12 SOUTH RECOVERY (NPI 1154789766) is a healthcare organization registered as a substance abuse rehabilitation facility in Lake Forest, California and active in the NPI registry since February 2016. The organization holds a CLIA Waiver certificate valid through June 26, 2028 and lists Kyle Smith, Ceo/owner, as its authorized official.

NPPES Registry Identity

NPI1154789766

Entity TypeOrganization

Primary Taxonomy324500000X

Legal Business Name12 SOUTH LLC

Location Address23712 BIRTCHER DRIVELake Forest, CA 92630

Mailing Address23712 Birtcher DriveLake Forest, CA 92630 · (714) 579-9304 · Fax (949) 215-6650

Phone(888) 830-8374

Fax(949) 215-6650

Organization SubpartNo

Authorized OfficialKyle SmithCeo/owner · (888) 830-8374

Enumeration DateFebruary 10, 2016

Last NPPES UpdateNovember 2, 20223 updates tracked since enumeration

NPPES CertifiedNovember 2, 2022

✔ NPI 1154789766 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities

Taxonomy Code324500000X

Definition

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X

Also ListedMarriage & Family TherapistTaxonomy 106H00000X

23712 BIRTCHER DRIVE, Lake Forest, CA 92630

Open in Google Maps ↗

Other Names 1

Other Name12 South Recovery

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2150589

12 South LLC · Lake Forest, CA

Active · expires Jun 26, 2028

CLIA Number05D2150589

Laboratory TypeOutpatient Treatment Ctr

Certificate Effective DateJune 27, 2026

Certificate Expiration DateJune 26, 2028

Laboratory DirectorAlejandro Alva MD

Laboratory Phone(888) 830-8374

Laboratory Location12 South LLC23712 Birtcher Dr, Lake Forest, CA 92630

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is 12 South LLC's NPI number?

The NPI number for 12 South LLC is 1154789766. It was assigned to this organization in the NPPES registry on February 10, 2016. The provider is also known as 12 South Recovery.

Where is 12 South LLC located?

12 South LLC is located at 23712 Birtcher Drive, Lake Forest, CA 92630. The listed phone number is (888) 830-8374.

What is 12 South LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does 12 South LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2150589) is associated with this NPI, valid through June 26, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for 12 South LLC was last updated on November 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.