Healthcare Provider Details

I. General information

NPI: 1922875301
Provider Name (Legal Business Name): CALIFORNIA MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14210 LESLEY LN
SAN MARTIN CA
95046-9606
US

IV. Provider business mailing address

2915 RED HILL AVE STE A200
COSTA MESA CA
92626-7978
US

V. Phone/Fax

Practice location:
  • Phone: 949-506-6162
  • Fax:
Mailing address:
  • Phone: 949-836-6793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: EMILY HINSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 949-506-6162