MEDICARE: HATCH 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	261QM0850X	Adult Mental Health Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1285331124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HATCH BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	3455 E LA PALMA AVE STE 205
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-2000
Country	:	US
Telephone Number	:	330-703-9594
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 E LA PALMA AVE STE 205
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92806-2000
Country	:	US
Telephone Number	:	330-703-9594
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ANTONIO PERA
Credential	:
Telephone Number	:	330-703-9594

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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