1104058403 NPI number — PACIFIC HILLS TREATMENT CENTERS, INC.

Table of content: (NPI 1104058403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104058403 NPI number — PACIFIC HILLS TREATMENT CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC HILLS TREATMENT CENTERS, INC.
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:
6
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:
1104058403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32236 PASEO ADELANTO
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
SAN JUAN CAPISTRANO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92675-3609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-248-5335
Provider Business Mailing Address Fax Number:
949-248-4275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27184 ORTEGA HWY STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN CAPISTRANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92675-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-248-5335
Provider Business Practice Location Address Fax Number:
949-248-4275
Provider Enumeration Date:
08/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SLOAN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
VP ADMINISTRATION
Authorized Official Telephone Number:
949-248-5335

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  300074DP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com