Provider Demographics
NPI:1972010650
Name:MOUNTAIN SIDE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:MOUNTAIN SIDE BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-II
Authorized Official - Phone:970-948-4129
Mailing Address - Street 1:70 COLLEGE WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5001
Mailing Address - Country:US
Mailing Address - Phone:970-948-4129
Mailing Address - Fax:
Practice Address - Street 1:70 COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5001
Practice Address - Country:US
Practice Address - Phone:970-948-4129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063779163OtherTHIS IS THE MEDICAL DIRECTOR