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2035 E Ball Rd Suite 100a And 100p Anaheim CA 92806-4599 | |
| (714) 517-6140 | |
| (714) 517-6169 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 2035 E Ball Rd, Anaheim, California |
| Authorized Official Name and Position | Chi Y Rajalingam (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 7148343154 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
405 W 5th St Ste 212 Santa Ana CA 92701-4522 Ph: (714) 568-5614 | 2035 E Ball Rd Suite 100a And 100p Anaheim CA 92806-4599 Ph: (714) 517-6140 |
| NPI Number | 1548383243 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 12/20/2019 |
| Certification Date | 12/20/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548383243 | NPI | - | NPPES |
| 308007 | Other | CA | ADP |
| 8007 | Medicaid | CA |
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