Healthcare Provider Details

I. General information

NPI: 1912567983
Provider Name (Legal Business Name): HOAG NEUROBEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SAND CANYON AVE
IRVINE CA
92618-3716
US

IV. Provider business mailing address

2975 RED HILL AVE STE 200
COSTA MESA CA
92626-1206
US

V. Phone/Fax

Practice location:
  • Phone: 949-557-0670
  • Fax: 949-450-0032
Mailing address:
  • Phone: 949-764-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN SPARKS
Title or Position: DIRECTOR, MANAGED CARE CONTRACTING
Credential:
Phone: 949-764-5700