| Renewed Community Mental Health | |
|
520 N Brookhurst St Ste 120 Anaheim CA 92801-5233 | |
| (714) 333-3559 | |
| (714) 333-3559 |
| Full Name | Renewed Community Mental Health |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 520 N Brookhurst St Ste 120, Anaheim, California |
| Authorized Official Name and Position | Jackson Tea (CFO) |
| Authorized Official Contact | 6264290088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewed Community Mental Health 11278 Los Alamitos Blvd Unit 905 Los Alamitos CA 90720-3958 Ph: (626) 429-0088 | Renewed Community Mental Health 520 N Brookhurst St Ste 120 Anaheim CA 92801-5233 Ph: (714) 333-3559 |
| NPI Number | 1912736026 |
|---|---|
| Provider Enumeration Date | 07/29/2024 |
| Last Update Date | 12/10/2024 |
| Certification Date | 12/10/2024 |
| Medicare PECOS PAC ID | 0244760882 |
|---|---|
| Medicare Enrollment ID | O20250211003349 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912736026 | NPI | - | NPPES |
| Provider Name | Medard Sison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922507037 PECOS PAC ID: 8820352057 Enrollment ID: I20180515002925 |
| Provider Name | Clint Nacar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609466259 PECOS PAC ID: 1153738232 Enrollment ID: I20210408000601 |
| Provider Name | Elizabeth Henderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164774576 PECOS PAC ID: 3375934185 Enrollment ID: I20220104002646 |
| Provider Name | Carly Marie Rorem |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1689197063 PECOS PAC ID: 6002352291 Enrollment ID: I20240724001548 |
| Provider Name | Jackson Tea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477365997 PECOS PAC ID: 5597295139 Enrollment ID: I20250219002194 |
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