Corktree Holdings, LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

Legal business name

CORKTREE HOLDINGS, LLC

Doing business as

Newport Beach Memory Care

Practice address

1000 Halyard
Newport Beach, CA 92663-2739

Phone

(949) 220-9700

NPI assigned

Apr 15, 2022

Organization subpart

No

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

Authorized official

Name

John Mitchell

Title

Secretary

Phone

(385) 988-3319

Specialties & licenses 1

Addresses

Other names 1

• Newport Beach Memory Care Doing business as

Locations

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

{
    "created_epoch": "1649980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1053054213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 N UNION AVE STE 320",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HALYARD",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926632739",
            "telephone_number": "949-220-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORKTREE HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-15",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "385-988-3319"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Newport Beach Memory Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Newport Beach Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bridget Cordray, PA-C
• Core Performance Physical Therapy, Inc.
• Aleyna Evonne Coria
• Corinne Ethel Dadivas
• Corinne Sugihara, M.D. (Corinne Sugihara, M.D. Inc.)
• Edward Cornejo, PT, MPT, CFMT
• Melanie Ann Cornejo, P.T.
• William J Cornejo
• Jacob Andrew Cornett, MD
• Crystal Marie Corona

• Alzheimer Center (Dementia Center) in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Alzheimer Center (Dementia Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.