MEDICARE: THE FRIEND SHIP OF ORANGE COUNTY

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
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	1084717	CA

General Provider Information

NPI Number	:	1881060515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FRIEND SHIP OF ORANGE COUNTY

Provider Business Mailing Address
First Line	:	31351 RANCHO VIEJO RD STE 107
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1857
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31351 RANCHO VIEJO RD STE 107
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1857
Country	:	US
Telephone Number	:	949-302-1992
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VALERIE CHEN
Credential	:	MA, BCBA
Telephone Number	:	949-302-1992

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

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Directions to “THE FRIEND SHIP OF ORANGE COUNTY ” Practice Location

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