Provider Demographics
NPI:1093238545
Name:MALLORY HILL
Entity Type:Organization
Organization Name:MALLORY HILL
Other - Org Name:WHISPERING PINES RETREAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-371-3573
Mailing Address - Street 1:668 N COAST HWY # 1112
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1513
Mailing Address - Country:US
Mailing Address - Phone:949-371-3573
Mailing Address - Fax:
Practice Address - Street 1:350 LAKE VIEW
Practice Address - Street 2:
Practice Address - City:TAHOMA
Practice Address - State:CA
Practice Address - Zip Code:96142
Practice Address - Country:US
Practice Address - Phone:949-371-3573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health