| Shore Light Behavioral Health Llc | |
|
411 Calle Macho San Clemente CA 92673-3035 | |
| (888) 486-6717 | |
| Not Available |
| Full Name | Shore Light Behavioral Health Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 411 Calle Macho, San Clemente, California |
| Authorized Official Name and Position | Stephen Vanhooser (DIRECTOR OF COMPLIANCE) |
| Authorized Official Contact | 9497502014 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shore Light Behavioral Health Llc 2955 E 1st Ave Ste 200 Denver CO 80206-5636 Ph: () - | Shore Light Behavioral Health Llc 411 Calle Macho San Clemente CA 92673-3035 Ph: (888) 486-6717 |
| NPI Number | 1114723616 |
|---|---|
| Provider Enumeration Date | 02/24/2025 |
| Last Update Date | 02/24/2025 |
| Certification Date | 02/24/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114723616 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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