Healthcare Provider Details

I. General information

NPI: 1245814292
Provider Name (Legal Business Name): BRICKFIRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 BROOKHOLLOW DR STE 106
SANTA ANA CA
92705-5428
US

IV. Provider business mailing address

20500 BELSHAW AVE. DPT XLA 1126
CARSON CA
90746-3506
US

V. Phone/Fax

Practice location:
  • Phone: 949-750-2720
  • Fax: 714-699-9492
Mailing address:
  • Phone: 949-750-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AARON BAILEY
Title or Position: GENERAL COUNSEL
Credential:
Phone: 714-352-9138