Provider Demographics
NPI:1073142907
Name:OCEANROCK, LLC
Entity Type:Organization
Organization Name:OCEANROCK, LLC
Other - Org Name:OCEANROCK RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAHAMTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMATBAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:949-375-5541
Mailing Address - Street 1:1100 QUAIL ST STE 205
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2700
Mailing Address - Country:US
Mailing Address - Phone:949-979-6866
Mailing Address - Fax:
Practice Address - Street 1:1100 QUAIL STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-979-6866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300428APOtherDEPARTMENT OF HEALTH CARE SERVICES (DHCS)