Healthcare Provider Details

I. General information

NPI: 1699189183
Provider Name (Legal Business Name): SOLID LANDINGS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BRISTOL ST STE B300
COSTA MESA CA
92626-5948
US

IV. Provider business mailing address

2900 BRISTOL ST STE B300
COSTA MESA CA
92626-5948
US

V. Phone/Fax

Practice location:
  • Phone: 949-467-9213
  • Fax:
Mailing address:
  • Phone: 949-467-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300276AP
License Number StateCA

VIII. Authorized Official

Name: STEVE FENNELLY
Title or Position: PRESIDENT & CEO
Credential:
Phone: 949-467-9213