Healthcare Provider Details

I. General information

NPI: 1588424519
Provider Name (Legal Business Name): VILLAGES OF CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W LA VETA AVE STE 205
ORANGE CA
92868-3929
US

IV. Provider business mailing address

805 W LA VETA AVE STE 205
ORANGE CA
92868-3929
US

V. Phone/Fax

Practice location:
  • Phone: 657-339-2799
  • Fax:
Mailing address:
  • Phone: 657-339-2799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CORY BROSCH
Title or Position: CHIEF OPERATING OFFICER
Credential: LMFT
Phone: 949-257-9128