Healthcare Provider Details

I. General information

NPI: 1275240434
Provider Name (Legal Business Name): TEAGLE HALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 W ALPINE AVE
SANTA ANA CA
92707-3934
US

IV. Provider business mailing address

3822 CAMPUS DR STE 500
NEWPORT BEACH CA
92660-2674
US

V. Phone/Fax

Practice location:
  • Phone: 657-304-0103
  • Fax:
Mailing address:
  • Phone: 262-490-7933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE BUCHEGER
Title or Position: BILLING DIRECTOR
Credential:
Phone: 262-490-7933