Healthcare Provider Details

I. General information

NPI: 1235847682
Provider Name (Legal Business Name): POPPY LIFE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 PLACENTIA AVE
NEWPORT BEACH CA
92663-3310
US

IV. Provider business mailing address

307 PLACENTIA AVE
NEWPORT BEACH CA
92663-3310
US

V. Phone/Fax

Practice location:
  • Phone: 949-307-3537
  • Fax:
Mailing address:
  • Phone: 949-307-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERICA SOLIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 949-307-3537