Basic Information
| Provider Information | |||||||||
| NPI: | 1962139212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHOENIX HOUSE ORANGE COUNTY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11600 ELDRIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE VIEW TERRACE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913426506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183848944 | ||||||||
| FaxNumber: | 8188964859 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 S ANITA DR | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6579334101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2022 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | TROCHIMCZYK | ||||||||
| AuthorizedOfficialFirstName: | MAJA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR DIRECTOR OF PLANNING & DEVEL | ||||||||
| AuthorizedOfficialTelephone: | 8186863112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 261QR0800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Recovery Care |
No ID Information.