Healthcare Provider Details

I. General information

NPI: 1841125739
Provider Name (Legal Business Name): TBH OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 GREEN RIVER RD FL 2
CORONA CA
92878-3831
US

IV. Provider business mailing address

39190 CORTE VENTURE
TEMECULA CA
92592-8062
US

V. Phone/Fax

Practice location:
  • Phone: 626-383-9067
  • Fax: 626-383-9067
Mailing address:
  • Phone: 626-383-9067
  • Fax: 626-383-9067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TRACY ROGERS
Title or Position: RCM
Credential: LMHC, LPC
Phone: 941-391-7261