=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942111836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AHS LONG BEACH OPERATING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2026
-----------------------------------------------------
Last Update Date | 09/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 W WARDLOW RD
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90806-1241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-800-2009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 CAMINO RAMON STE 110
-----------------------------------------------------
City | SAN RAMON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94583-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-800-2009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BEATA DOMINICI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-800-2009
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------