Basic Information
| Provider Information | |||||||||
| NPI: | 1841382736 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FLORENCE CRITTENTON SERVICES OF ORANGE COUNTY, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CRITTENTON SERVICES FOR CHILDREN & FAMILIES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 E CHAPMAN AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928313839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146808268 | ||||||||
| FaxNumber: | 7146808207 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 E CHAPMAN AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928313839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146808268 | ||||||||
| FaxNumber: | 7146808207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 05/16/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CZYPULL | ||||||||
| AuthorizedOfficialFirstName: | MANFRED | ||||||||
| AuthorizedOfficialMiddleName: | FRITZ | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7146808268 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MIM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 300612972 | CA | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
ID Information
| ID | Type | State | Issuer | Description | 300612972 | 01 | CA | DSS FACILITY LICENSE | OTHER | 7605 | 01 | CA | MEDICAL CERTIFICATION LB | OTHER | 7518 | 01 | CA | MEDICAL CERTIFICATION C. | OTHER | 7554 | 01 | CA | MEDICAL CERTIFICATION B | OTHER | 306099612 | 01 | CA | DSS FACILITY LICENSE | OTHER | 7523 | 01 | CA | MEDICAL CERTIFICATION H | OTHER | 7524 | 01 | CA | MEDICAL CERTIFICATION VV | OTHER | 00870 | 01 | CA | MH LEGAL ENTITY | OTHER | 300600336 | 01 | CA | DSS FACILITY LICENSE | OTHER |