Healthcare Provider Details

I. General information

NPI: 1225015985
Provider Name (Legal Business Name): VSC HBO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 S TUSTIN ST
ORANGE CA
92866-2501
US

IV. Provider business mailing address

393 S TUSTIN ST
ORANGE CA
92866-2501
US

V. Phone/Fax

Practice location:
  • Phone: 714-289-2400
  • Fax: 714-289-2367
Mailing address:
  • Phone: 714-289-2400
  • Fax: 714-289-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number060000530
License Number StateCA

VIII. Authorized Official

Name: ROBERTA CONSOLVER
Title or Position: CEO
Credential: RN
Phone: 714-289-2400