Healthcare Provider Details

I. General information

NPI: 1316856743
Provider Name (Legal Business Name): LONG BEACH SHORES BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5723 ATLANTIC AVE
LONG BEACH CA
90805-4712
US

IV. Provider business mailing address

PO BOX 9047
WHITTIER CA
90608-9047
US

V. Phone/Fax

Practice location:
  • Phone: 213-925-4862
  • Fax:
Mailing address:
  • Phone: 213-925-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BARRERA
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 213-925-4862