MEDICARE: BRIDGECREST BEHAVIORAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1154276418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGECREST BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	509 N FAIRFAX AVE STE 228
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-1782
Country	:	US
Telephone Number	:	310-800-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 N FAIRFAX AVE STE 228
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-1782
Country	:	US
Telephone Number	:	310-800-2266
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANDREW ROLETTI
Credential	:	CADC-II, CAMS-I
Telephone Number	:	310-800-2266

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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