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General NPI Number Information
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NPI Number | 1902602402
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Entity Type | Organization
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Legal Business Name | SHORE LIGHT BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 25542 RHODA DR
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City | MISSION VIEJO
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State | CA
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Zip | 92691-4669
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Country | US
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Telephone | 888-486-6717
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Fax |
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Provider Business Mailing Address
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Address Line | 2955 E 1ST AVE STE 200
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City | DENVER
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State | CO
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Zip | 80206-5636
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | STEPHEN VANHOOSER
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Credential |
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Telephone | 949-750-2014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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