Provider Demographics
NPI:1215081229
Name:MIRAMAR HEALTH, INC.
Entity type:Organization
Organization Name:MIRAMAR HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-717-4797
Mailing Address - Street 1:23293 S POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1441
Mailing Address - Country:US
Mailing Address - Phone:949-717-4797
Mailing Address - Fax:
Practice Address - Street 1:2542 N HESPERIAN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-1434
Practice Address - Country:US
Practice Address - Phone:949-989-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300182AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility