Provider Demographics
| NPI: | 1134808553 |
|---|---|
| Name: | SOLSTICE SOUTHWEST |
| Entity type: | Organization |
| Organization Name: | SOLSTICE SOUTHWEST |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | BRITTEN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | DEVEREUX |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | LCDC |
| Authorized Official - Phone: | 949-402-9520 |
| Mailing Address - Street 1: | 26732 CROWN VALLEY PKWY STE 443 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MISSION VIEJO |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 92691-6375 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 949-402-9520 |
| Mailing Address - Fax: | 949-200-7929 |
| Practice Address - Street 1: | 3421 STORY RD W |
| Practice Address - Street 2: | |
| Practice Address - City: | IRVING |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 75038-3571 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 214-306-8447 |
| Practice Address - Fax: | 949-200-7929 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-07-13 |
| Last Update Date: | 2024-05-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | ||
| No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | Group - Multi-Specialty |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | ||
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
