Healthcare Provider Details

I. General information

NPI: 1972060747
Provider Name (Legal Business Name): EYS MANAGEMENT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 S MOUNTVALE CT
ANAHEIM CA
92808-2108
US

IV. Provider business mailing address

PO BOX 28253
ANAHEIM CA
92809-0100
US

V. Phone/Fax

Practice location:
  • Phone: 714-281-1000
  • Fax:
Mailing address:
  • Phone: 714-616-7337
  • Fax: 888-320-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC SCOTT CUNNINGHAM
Title or Position: CEO
Credential:
Phone: 714-616-7337