Healthcare Provider Details

I. General information

NPI: 1730787516
Provider Name (Legal Business Name): CENTRAL COUNTY SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 MCCABE WAY STE 200
IRVINE CA
92614-9402
US

IV. Provider business mailing address

2515 MCCABE WAY STE 200
IRVINE CA
92614-9402
US

V. Phone/Fax

Practice location:
  • Phone: 949-955-9000
  • Fax:
Mailing address:
  • Phone: 949-757-3760
  • 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: MARK ODOM
Title or Position: VICE PRESIDENT
Credential: LCSW
Phone: 949-757-3760