Healthcare Provider Details

I. General information

NPI: 1396870549
Provider Name (Legal Business Name): COLLEGE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W KATELLA AVE SUITE 150 AND 270
ORANGE CA
92867-3451
US

IV. Provider business mailing address

8337 TELEGRAPH RD STE 300
PICO RIVERA CA
90660-4957
US

V. Phone/Fax

Practice location:
  • Phone: 714-399-3480
  • Fax: 714-399-3481
Mailing address:
  • Phone: 562-467-5440
  • Fax: 562-467-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TRACY GINTER
Title or Position: DIRECTOR OF STATE OPERATIONS
Credential: MBA, CBCS
Phone: 657-465-9497