Provider Demographics
NPI:1023565579
Name:AMERICAN ADDICTION INSTITUTE OF MIND AND MEDICINE
Entity Type:Organization
Organization Name:AMERICAN ADDICTION INSTITUTE OF MIND AND MEDICINE
Other - Org Name:CALIFORNIA ADDICTION INSTITUTE OF MIND AND MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FARIED
Authorized Official - Middle Name:
Authorized Official - Last Name:BANIMAHD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-347-8721
Mailing Address - Street 1:1835 NEWPORT BLVD. A109-559
Mailing Address - Street 2:COSTA MESA
Mailing Address - City:CALIFORNIA
Mailing Address - State:CA
Mailing Address - Zip Code:92627
Mailing Address - Country:US
Mailing Address - Phone:949-929-6203
Mailing Address - Fax:
Practice Address - Street 1:1533 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5115
Practice Address - Country:US
Practice Address - Phone:800-779-4715
Practice Address - Fax:949-347-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100516261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder