=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023828852
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AXIS MENTAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 NEWPORT CENTER DRIVE SUITE 450
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-933-7608
-----------------------------------------------------
Fax | 949-200-4512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 NEWPORT CENTER DRIVE SUITE 450
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMPLIANCE DIRECTOR
-----------------------------------------------------
Name | MRS. CASEY POSTMA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-739-0878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------