Provider Demographics
NPI:1902670185
Name:OCEANROCK, LLC
Entity Type:Organization
Organization Name:OCEANROCK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAHAMTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMATBAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:949-375-5541
Mailing Address - Street 1:1100 QUAIL ST STE 205
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2700
Mailing Address - Country:US
Mailing Address - Phone:949-979-6866
Mailing Address - Fax:
Practice Address - Street 1:2655 VILLA CREEK DR STE 111
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7396
Practice Address - Country:US
Practice Address - Phone:214-347-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCEANROCK, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4933-4934OtherTEXAS HEALTH AND HUMAN SERVICES