Insurance Inquiry
858-775-9993   FAX-858-385-9456   Our NPI No. is 1346564754

We do have treatment financing available.
 
Please provide some basic information and we will help you. 


 

Name (First, Middle, Last):

Address:

City:

State:

Zip:

Phone:

Evening Phone:

Married/Single, Family Members:

Insurance Company

Insurance Company Name:

 

Insurance Comany Phone Number:

Policy Number:

Insurance Group Number:

Plan:

Effective Date:

Insured Party

Insured Name:

 

Relation to Patient::

Social Security Number:

Date of Birth:

Employer/Self-Employed-Occupation:

Term Date:

Insured Date of Birth:

Insured Social Security Number:

Are you Self -Employed?

Estimated Annual Income:

Upon receipt and review we will respond to you promptly. Please call now if you have any questions.
Copyright © 2010, Advanced Drug Rehab. All rights reserved.
The Advanced Drug Rehab Centers are recognized around the world as leaders in Addiction and Behavioral Health Treatment.
The success of our programs have given patients their best opportunity to reclaim their life and achieve sustained recovery.
We are a clinical facility, all professionals fully licensed by the State of California. Admission based upon availability.
THE COMPREHENSIVE WHOLE PERSON 'holistic' TREATMENT