Organization
BARN LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER PENROD (AUTHORIZED REP)
(832) 289-9225
Entity
Organization
Contact information
Practice address
126 E 16TH ST, COSTA MESA, CA 92627-7704
(949) 229-6853
(512) 532-0923
Mailing address
126 E 16TH ST, COSTA MESA, CA 92627-7704
(949) 229-6853
(512) 532-0923
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
306005512
DEPARTMENT OF HEALTH CARE SERVICES
CA
Enumeration date
10/17/2018
Last updated
10/17/2018
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