Beach House Retreat

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

BEACH HOUSE RETREAT

Practice address

628 11TH St
Huntington Beach, CA 92648-4032

Phone

(949) 629-8515

Fax

(877) 963-6329

NPI assigned

Mar 13, 2020

Organization subpart

No

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

Authorized official

Name

Mariah Ulloa

Title

Owner

Phone

(949) 629-8515

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1584057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584057600000",
    "number": "1154957967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 IRVINE AVE",
            "address_2": "SUITE 877",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "92660",
            "telephone_number": "949-629-8515",
            "fax_number": "877-963-6329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 11TH ST",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926484032",
            "telephone_number": "949-629-8515",
            "fax_number": "877-963-6329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACH HOUSE RETREAT",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-13",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A",
        "authorized_official_last_name": "ULLOA",
        "authorized_official_first_name": "MARIAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-629-8515"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHCS",
            "identifier": "300287AP",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.