Healthcare Provider Details

I. General information

NPI: 1336858679
Provider Name (Legal Business Name): HOMELESS INTERVENTION SERVICES OF ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 N BRADFORD AVE
PLACENTIA CA
92870-4516
US

IV. Provider business mailing address

907 N BRADFORD AVE
PLACENTIA CA
92870-4516
US

V. Phone/Fax

Practice location:
  • Phone: 714-993-5774
  • Fax:
Mailing address:
  • Phone: 714-993-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: CARRIE BUCK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 714-993-5774