Healthcare Provider Details

I. General information

NPI: 1033730379
Provider Name (Legal Business Name): HILLSDALE TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E 4TH ST STE 100
SANTA ANA CA
92701-5114
US

IV. Provider business mailing address

220 NEWPORT CENTER DR # 11-583
NEWPORT BEACH CA
92660-7506
US

V. Phone/Fax

Practice location:
  • Phone: 949-635-4437
  • Fax:
Mailing address:
  • Phone: 949-635-4437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC NIN
Title or Position: MANAGER
Credential:
Phone: 949-635-4437