Provider Demographics
NPI:1942772496
Name:EXECUTIVE HEALTH CARE MANAGEMENT, INC.
Entity Type:Organization
Organization Name:EXECUTIVE HEALTH CARE MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:VADEN
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS
Authorized Official - Phone:949-370-6018
Mailing Address - Street 1:2618 SAN MIGUEL DR STE 345
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5437
Mailing Address - Country:US
Mailing Address - Phone:949-370-6018
Mailing Address - Fax:
Practice Address - Street 1:9432 ALDERBURY ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2850
Practice Address - Country:US
Practice Address - Phone:949-370-6018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility