Provider Demographics
NPI:1376278655
Name:MISSION PREP HEALTHCARE
Entity type:Organization
Organization Name:MISSION PREP HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-424-9921
Mailing Address - Street 1:30310 RANCHO VIEJO RD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1576
Mailing Address - Country:US
Mailing Address - Phone:949-313-7444
Mailing Address - Fax:949-579-2876
Practice Address - Street 1:28111 PALOS VERDES DR E
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-5120
Practice Address - Country:US
Practice Address - Phone:424-328-5480
Practice Address - Fax:949-579-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA191230APOtherSTATE OF CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES
CA198209767OtherSTATE OF CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CA578314OtherTHE JOINT COMMISSION