Healthcare Provider Details

I. General information

NPI: 1962139212
Provider Name (Legal Business Name): PHOENIX HOUSE ORANGE COUNTY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S ANITA DR
ORANGE CA
92868-3355
US

IV. Provider business mailing address

11600 ELDRIDGE AVE
LAKE VIEW TERRACE CA
91342-6506
US

V. Phone/Fax

Practice location:
  • Phone: 657-933-4101
  • Fax:
Mailing address:
  • Phone: 818-384-8944
  • Fax: 818-896-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAJA TROCHIMCZYK
Title or Position: SENIOR DIRECTOR OF PLANNING & DEVEL
Credential: PH.D.
Phone: 818-686-3112