MEDICARE: SOUTH COAST BEHAVIORAL HEALTH

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1669201612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COAST BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	2220 UNIVERSITY DR
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-3319
Country	:	US
Telephone Number	:	949-531-1821
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 W BALBOA BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92661-1091
Country	:	US
Telephone Number	:	949-531-1821
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KYLEE BRINEY
Credential	:
Telephone Number	:	949-531-1821

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	07/29/2024

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