Provider Demographics
NPI:1780153882
Name:AKUA BEHAVIORAL HEALTH, INC
Entity type:Organization
Organization Name:AKUA BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-833-8100
Mailing Address - Street 1:20271 SW BIRCH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1752
Mailing Address - Country:US
Mailing Address - Phone:949-833-8103
Mailing Address - Fax:
Practice Address - Street 1:2754 IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4031
Practice Address - Country:US
Practice Address - Phone:949-350-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone