Healthcare Provider Details

I. General information

NPI: 1043395742
Provider Name (Legal Business Name): THC - ORANGE COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N MONTEREY AVE
ONTARIO CA
91764
US

IV. Provider business mailing address

550 N MONTEREY AVE
ONTARIO CA
91764-3318
US

V. Phone/Fax

Practice location:
  • Phone: 909-391-0333
  • Fax: 909-391-2892
Mailing address:
  • Phone: 909-391-0333
  • Fax: 909-391-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number240000561
License Number StateCA

VIII. Authorized Official

Name: JOHNETTA TRAYLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 502-596-6063