| Barn Life LLC | |
|
126 E 16th St Costa Mesa CA 92627-7704 | |
| (949) 229-6853 | |
| (512) 532-0923 |
| Full Name | Barn Life LLC |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 126 E 16th St, Costa Mesa, California |
| Authorized Official Name and Position | Tyler Penrod (AUTHORIZED REP) |
| Authorized Official Contact | 8322899225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Barn Life LLC 126 E 16th St Costa Mesa CA 92627-7704 Ph: (949) 229-6853 | Barn Life LLC 126 E 16th St Costa Mesa CA 92627-7704 Ph: (949) 229-6853 |
| NPI Number | 1083180095 |
|---|---|
| Provider Enumeration Date | 10/17/2018 |
| Last Update Date | 10/17/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083180095 | NPI | - | NPPES |
| 306005512 | Other | CA | DEPARTMENT OF HEALTH CARE SERVICES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | () | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | () | Secondary |
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