Provider Demographics
NPI:1295253300
Name:CENTER FOR HUMAN POTENTIAL LLC
Entity type:Organization
Organization Name:CENTER FOR HUMAN POTENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:949-237-0893
Mailing Address - Street 1:3151 AIRWAY AVE STE P3
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4626
Mailing Address - Country:US
Mailing Address - Phone:310-422-6744
Mailing Address - Fax:
Practice Address - Street 1:3151 AIRWAY AVE STE P3
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4626
Practice Address - Country:US
Practice Address - Phone:310-422-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness