Provider Demographics
NPI:1679303143
Name:SOUTH COAST BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:SOUTH COAST BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-531-1821
Mailing Address - Street 1:2220 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3319
Mailing Address - Country:US
Mailing Address - Phone:949-531-1821
Mailing Address - Fax:
Practice Address - Street 1:11851 WISTERIA AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2654
Practice Address - Country:US
Practice Address - Phone:949-531-1821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH COAST BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility