Provider Demographics
NPI:1447842760
Name:MENTAL HEALTH HOUSE LLC
Entity type:Organization
Organization Name:MENTAL HEALTH HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-303-8951
Mailing Address - Street 1:4701 TELLER AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8144
Mailing Address - Country:US
Mailing Address - Phone:949-303-8951
Mailing Address - Fax:
Practice Address - Street 1:137 THE MASTERS CIR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4640
Practice Address - Country:US
Practice Address - Phone:949-371-2414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness