Provider Demographics
NPI:1114451663
Name:AKUA BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:AKUA BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-833-8101
Mailing Address - Street 1:20271 SW BIRCH ST
Mailing Address - Street 2:STE-200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1752
Mailing Address - Country:US
Mailing Address - Phone:949-833-8101
Mailing Address - Fax:
Practice Address - Street 1:10087 TERRA LOMA DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-3202
Practice Address - Country:US
Practice Address - Phone:949-833-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340113AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility