Provider Demographics
NPI:1386205680
Name:AKUA BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:AKUA BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCURIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-777-2283
Mailing Address - Street 1:20271 SW BIRCH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1752
Mailing Address - Country:US
Mailing Address - Phone:949-777-2283
Mailing Address - Fax:
Practice Address - Street 1:10821 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7214
Practice Address - Country:US
Practice Address - Phone:949-777-2283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility