Healthcare Provider Details

I. General information

NPI: 1346564754
Provider Name (Legal Business Name): MHCD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11828 RANCHO BERNARDO RD SUITE 201
SAN DIEGO CA
92128-1912
US

IV. Provider business mailing address

555 W COUNTRY CLUB LN SUITE C230
ESCONDIDO CA
92026-1226
US

V. Phone/Fax

Practice location:
  • Phone: 858-385-9399
  • Fax:
Mailing address:
  • Phone: 760-751-2889
  • Fax: 858-385-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number2008004482
License Number StateCA

VIII. Authorized Official

Name: MR. LARRY BURNS I
Title or Position: DIRECTOR
Credential:
Phone: 858-385-9399