Healthcare Provider Details

I. General information

NPI: 1154714640
Provider Name (Legal Business Name): WESTMONT HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 W ROWAN ST
ANAHEIM CA
92801
US

IV. Provider business mailing address

5753-G E. SANTA ANA CANYON RD #245
ANAHEIM CA
92807
US

V. Phone/Fax

Practice location:
  • Phone: 714-283-2085
  • Fax: 714-283-2230
Mailing address:
  • Phone: 714-283-2085
  • Fax: 714-283-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberC3752427
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberC3752427
License Number StateCA

VIII. Authorized Official

Name: DR. ARI M YAZDAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential: M.D.
Phone: 714-283-2085