Organization
THE OPEN TABLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW HEIM M.A., J.D. (DIRECTOR)
(949) 274-9627
Entity
Organization
Contact information
Practice address
151 KALMUS DR. BLDG C, SUITE 100, COSTA MESA, CA 92626
(949) 274-9627
Mailing address
1633 E 4TH ST STE 120, SANTA ANA, CA 92701-5143
(949) 274-9627
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
12/12/2019
Last updated
12/12/2019
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