NPIMap

Organization Active NPI

Solta Development LLC

Doing business as Long Beach Residential

  • Mental Illness Community Based Residential Treatment Facility
  • Long Beach, CA
National Provider Identifier
1013556471
Registry record updated Jan 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
SOLTA DEVELOPMENT LLC
Doing business as
Long Beach Residential
Practice address
4201 E 10TH St
Long Beach, CA 90804-5508
Phone
(818) 846-4469
NPI assigned
Jan 3, 2020
Last updated
Jan 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Teodulo BonzonNPI 1497039192
Title
Administrator
Phone
(818) 846-4469

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

4201 E 10TH St
Long Beach, CA 90804-5508

Mailing address

3013 Annita Dr
Glendale, CA 91206-1302
Phone (818) 846-4469

Other names 1

  • Long Beach Residential Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Hubchart Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578009600000",
    "number": "1013556471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3013 ANNITA DR",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912061302",
            "telephone_number": "818-846-4469",
            "fax_number": "818-457-5577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 E 10TH ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908045508",
            "telephone_number": "818-846-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLTA DEVELOPMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-03",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A",
        "authorized_official_last_name": "BONZON",
        "authorized_official_first_name": "TEODULO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "818-846-4469"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Hubchart",
            "affiliation": "N",
            "endpointDescription": "HIPAA compliant app",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Protected Health Information",
            "address_1": "4201 E 10th St",
            "city": "Long Beach",
            "state": "CA",
            "country_code": "US",
            "postal_code": "908045508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Long Beach Residential",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.