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General NPI Number Information
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NPI Number | 1912423385
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Entity Type | Organization
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Legal Business Name | UNIFIED BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 08/17/2017
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Provider Practice Location Address
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Address Line | 12672 CHARMAINE LN
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City | SANTA ANA
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State | CA
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Zip | 92705-1222
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Country | US
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Telephone | 949-344-2742
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 SE BRISTOL ST STE 200
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1528
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Country | US
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Telephone | 949-344-2742
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | SCOTT WILSON
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Credential |
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Telephone | 949-344-2742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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