Healthcare Provider Details

I. General information

NPI: 1871283598
Provider Name (Legal Business Name): HOAG NEUROBEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16305 SAND CANYON AVE STE 210
IRVINE CA
92618-3783
US

IV. Provider business mailing address

2995 RED HILL AVE STE 100
COSTA MESA CA
92626-5984
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-7239
  • Fax:
Mailing address:
  • Phone: 949-764-5700
  • Fax: 949-764-5820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MAUREEN SPARKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 949-764-5700