Healthcare Provider Details

I. General information

NPI: 1346254778
Provider Name (Legal Business Name): PROVIDENCE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 CABRILLO PARK DR Q14
SANTA ANA CA
92701-3108
US

IV. Provider business mailing address

1345 CABRILLO PARK DR Q14
SANTA ANA CA
92701-3108
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-5440
  • Fax: 949-515-5444
Mailing address:
  • Phone: 949-515-5440
  • Fax: 949-515-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number251B00000X
License Number StateCA

VIII. Authorized Official

Name: MS. ELIZABETH WARD
Title or Position: CLINICAL DIRECTOR
Credential: LMFT
Phone: 949-515-5440