Provider Demographics
NPI:1689930596
Name:DISCOVERY PRACTICE MANAGEMENT, INC.
Entity Type:Organization
Organization Name:DISCOVERY PRACTICE MANAGEMENT, INC.
Other - Org Name:CENTER FOR DISCOVERY & ADOLESCENT CHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-568-7667
Mailing Address - Street 1:18401 VON KARMAN AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-8531
Mailing Address - Country:US
Mailing Address - Phone:714-828-1800
Mailing Address - Fax:714-882-1186
Practice Address - Street 1:9844 PANGBORN AVENUE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240
Practice Address - Country:US
Practice Address - Phone:714-828-1800
Practice Address - Fax:714-882-1186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL HEALTH HOLDINGS II, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-04
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001593323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA980001593OtherDEPARTMENT OF PUBLIC HEALTH