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2 Corporate Plaza Dr Suite 200 Newport Beach CA 92660-7929 | |
| (305) 663-1876 | |
| (786) 359-4485 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2 Corporate Plaza Dr, Newport Beach, California |
| Authorized Official Name and Position | Mike Bagley (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3056631876 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6100 Sw 76th Street South Miami FL 33143 Ph: (305) 663-1876 | 2 Corporate Plaza Dr Suite 200 Newport Beach CA 92660-7929 Ph: (305) 663-1876 |
| NPI Number | 1952857336 |
|---|---|
| Provider Enumeration Date | 08/26/2016 |
| Last Update Date | 08/03/2020 |
| Certification Date | 08/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952857336 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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