Provider Demographics
NPI:1801328505
Name:HILLSIDE MISSION
Entity type:Organization
Organization Name:HILLSIDE MISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRSKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-359-8273
Mailing Address - Street 1:PO BOX 5259
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92674-5259
Mailing Address - Country:US
Mailing Address - Phone:949-625-0376
Mailing Address - Fax:949-390-9899
Practice Address - Street 1:23371 ROCKROSE
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-1686
Practice Address - Country:US
Practice Address - Phone:949-518-3468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300014APMedicaid