Provider Demographics
NPI:1093202434
Name:SOUTH COAST BEHAVIORAL HEALTH GUESTHOUSE INCORPORATION
Entity Type:Organization
Organization Name:SOUTH COAST BEHAVIORAL HEALTH GUESTHOUSE INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-467-4324
Mailing Address - Street 1:3151 AIRWAY AVE STE T2
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4627
Mailing Address - Country:US
Mailing Address - Phone:714-312-5058
Mailing Address - Fax:
Practice Address - Street 1:3151 AIRWAY AVE STE T2
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4627
Practice Address - Country:US
Practice Address - Phone:714-312-5058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300313AP324500000X
CA300313BP324500000X
CA300313DP324500000X
CA300313FP324500000X
CA300313CP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility