Basic Information
| Provider Information | |||||||||
| NPI: | 1225321185 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIRAMAR HEALTH INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 EMERALD BAY | ||||||||
| Address2: | |||||||||
| City: | LAGUNA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926511273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009900340 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 DAHLIA AVENUE | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009900340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2011 | ||||||||
| LastUpdateDate: | 05/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | BRIAN | ||||||||
| AuthorizedOfficialFirstName: | DERIK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8009900340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.