Provider Demographics
NPI:1922378215
Name:AURORA BEHAVIORAL HEALTHCARE - SANTA ROSA, LLC
Entity type:Organization
Organization Name:AURORA BEHAVIORAL HEALTHCARE - SANTA ROSA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-905-5091
Mailing Address - Street 1:1287 FULTON RD.
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4923
Mailing Address - Country:US
Mailing Address - Phone:707-800-7700
Mailing Address - Fax:707-800-7797
Practice Address - Street 1:1287 FULTON RD.
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4923
Practice Address - Country:US
Practice Address - Phone:707-800-7700
Practice Address - Fax:707-800-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922378215Medicaid
CA1922378215Medicaid