Healthcare Provider Details

I. General information

NPI: 1154276418
Provider Name (Legal Business Name): BRIDGECREST BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N FAIRFAX AVE STE 228
LOS ANGELES CA
90036-1782
US

IV. Provider business mailing address

509 N FAIRFAX AVE STE 230
LOS ANGELES CA
90036-1782
US

V. Phone/Fax

Practice location:
  • Phone: 310-800-2266
  • Fax:
Mailing address:
  • Phone: 310-800-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ANDREW ROLETTI
Title or Position: DIRECTOR
Credential: CADC-II, CAMS-I
Phone: 310-800-2266