Healthcare Provider Details

I. General information

NPI: 1295822567
Provider Name (Legal Business Name): HEALTH CARE AGENCY BH AMH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN STREET
SANTA ANA CA
92701
US

IV. Provider business mailing address

1200 N MAIN STREET
SANTA ANA CA
92701
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-6767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MISS ANNETTE MUGRDITCHIAN
Title or Position: PROGRAM MANAGER
Credential:
Phone: 714-834-5026