Provider Demographics
NPI:1740840701
Name:HOAG NEUROBEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:HOAG NEUROBEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, MANAGED CARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-764-5700
Mailing Address - Street 1:2975 RED HILL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1206
Mailing Address - Country:US
Mailing Address - Phone:949-764-4624
Mailing Address - Fax:
Practice Address - Street 1:500 SUPERIOR AVE STE 315
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3660
Practice Address - Country:US
Practice Address - Phone:949-764-8191
Practice Address - Fax:949-764-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health