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NPI Code Detail

MEDICARE: PHOENIX HOUSE ORANGE COUNTY, INC.

MEDICARE: PHOENIX HOUSE ORANGE COUNTY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0800XRecovery Care Clinic/Center
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1154081867
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOENIX HOUSE ORANGE COUNTY, INC.
Provider Business Mailing Address
First Line : 11600 ELDRIDGE AVE
Second Line :
City : LAKE VIEW TERRACE
State : CA
Zip : 91342-6506
Country : US
Telephone Number : 818-686-3112
Fax Number : 818-897-1293
Provider Business Practice Location Address
First Line : 1901 E 4TH ST STE 350
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3908
Country : US
Telephone Number : 714-486-0940
Fax Number : 714-546-5496
Authorized Official
Title or Position : SENIOR DIRECTOR OF PLANNING
Name : MAJA TROCHIMCZYK
Credential : PH.D.
Telephone Number : 818-686-3112
Provider Enumeration Date : 12/21/2021
Last Update Date : 12/21/2021

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Directions to “PHOENIX HOUSE ORANGE COUNTY, INC. ” Practice Location

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