Healing Source Medical, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

HEALING SOURCE MEDICAL, INC.

Practice address

1601 Dove St Ste 185
Newport Beach, CA 92660-2441

Phone

(949) 416-2183

NPI assigned

Oct 24, 2017

Organization subpart

No

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

Authorized official

Name

Charles ChaneyNPI 1184990087

Title

Chief Executive Officer

Phone

(949) 416-2183

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Chaney, MD

  • Psychiatry Physician
  • Washington, DC
  • NPI 1184990087
  NPD Authorized official

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

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508803200000",
    "number": "1649781121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 DOVE ST STE 185",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602441",
            "telephone_number": "949-416-2183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 DOVE ST STE 185",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602441",
            "telephone_number": "949-416-2183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALING SOURCE MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-24",
        "last_updated": "2017-10-24",
        "status": "A",
        "authorized_official_last_name": "CHANEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "949-416-2183"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; 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.