Healthcare Provider Details

I. General information

NPI: 1760266472
Provider Name (Legal Business Name): THE SALVATION ARMY - A CALIFORNIA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 S. SALVATION PLACE
ANAHEIM CA
92805
US

IV. Provider business mailing address

10200 PIONEER RD.
TUSTIN CA
92782
US

V. Phone/Fax

Practice location:
  • Phone: 714-210-6037
  • Fax:
Mailing address:
  • Phone: 714-210-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN HURST
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 714-210-6037