Healthcare Provider Details

I. General information

NPI: 1154081867
Provider Name (Legal Business Name): PHOENIX HOUSE ORANGE COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E 4TH ST STE 350
SANTA ANA CA
92705-3908
US

IV. Provider business mailing address

11600 ELDRIDGE AVE
LAKE VIEW TERRACE CA
91342-6506
US

V. Phone/Fax

Practice location:
  • Phone: 714-486-0940
  • Fax: 714-546-5496
Mailing address:
  • Phone: 818-686-3112
  • Fax: 818-897-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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