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General NPI Number Information
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NPI Number | 1376013144
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Entity Type | Organization
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Legal Business Name | AHORA WELLNESS CENTERS LLC
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 537 MAIN ST
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City | BRAWLEY
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State | CA
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Zip | 92227-2423
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Country | US
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Telephone | 760-344-9000
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Fax | 760-344-9002
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Provider Business Mailing Address
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Address Line | 302 WASHINGTON ST # 754
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City | SAN DIEGO
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State | CA
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Zip | 92103-2110
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Country | US
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Telephone | 619-203-5336
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STACEY HOYT
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Credential | PH.D.
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Telephone | 619-203-5336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1000X
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Taxonomy Name | Migrant Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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