Healthcare Provider Details

I. General information

NPI: 1245485812
Provider Name (Legal Business Name): CORRECTIONAL MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 THE CITY DR S
ORANGE CA
92868-3305
US

IV. Provider business mailing address

501 THE CITY DR S
ORANGE CA
92868-3305
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-6091
  • Fax: 714-935-6196
Mailing address:
  • Phone: 714-935-6091
  • Fax: 714-935-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License NumberPT31862
License Number StateCA

VIII. Authorized Official

Name: MS. ROSANGELA QUIROZ
Title or Position: MENTAL HEALTH SPECIALIST
Credential: LPT
Phone: 714-935-6091