Healthcare Provider Details

I. General information

NPI: 1295812626
Provider Name (Legal Business Name): PHOENIX HOUSE ORANGE COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E FRUIT ST
SANTA ANA CA
92701-4206
US

IV. Provider business mailing address

11600 ELDRIDGE AVE
LAKE VIEW TERRACE CA
91342-6506
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-9373
  • Fax: 714-953-7573
Mailing address:
  • Phone: 818-686-3000
  • Fax: 818-896-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number300605606
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300033CN
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number300605606
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number300033AN
License Number StateCA

VIII. Authorized Official

Name: MS. SHAWNA RENEE MORRIS
Title or Position: SENIOR VICE PRESIDENT & EXECUTIVE D
Credential:
Phone: 818-686-3011