Healthcare Provider Details

I. General information

NPI: 1750197836
Provider Name (Legal Business Name): AXIS MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66563 5TH STREET UNIT C
DESERT HOT SPRINGS CA
92240
US

IV. Provider business mailing address

620 NEWPORT CENTER DRIVE SUITE 450
NEWPORT BEACH CA
92660
US

V. Phone/Fax

Practice location:
  • Phone: 949-685-0041
  • Fax: 949-200-4512
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CASEY POSTMA
Title or Position: COMPLIANCE DIRECTOR
Credential:
Phone: 562-739-0878