1811476971 NPI number — OCEAN VALLEY BEHAVIORAL HEALTH LLC

Table of content: (NPI 1811476971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811476971 NPI number — OCEAN VALLEY BEHAVIORAL HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN VALLEY BEHAVIORAL HEALTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811476971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1237
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92647-1237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-274-6920
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13961 MAUVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-2649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-274-6920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
EAST
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
949-274-6920

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com