Provider Demographics
NPI:1043949456
Name:ACERA HEALTH, LLC
Entity Type:Organization
Organization Name:ACERA HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAILY
Authorized Official - Middle Name:ELEANOR
Authorized Official - Last Name:GOUGER
Authorized Official - Suffix:
Authorized Official - Credentials:RADT
Authorized Official - Phone:949-234-6587
Mailing Address - Street 1:3151 AIRWAY AVE STE P3
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4626
Mailing Address - Country:US
Mailing Address - Phone:949-228-4381
Mailing Address - Fax:
Practice Address - Street 1:2329 PURDUE DR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6365
Practice Address - Country:US
Practice Address - Phone:844-223-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306006072OtherDSS