Healthcare Provider Details

I. General information

NPI: 1730422676
Provider Name (Legal Business Name): JOHN HENRY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 N SUSAN ST
SANTA ANA CA
92703-3433
US

IV. Provider business mailing address

403 N SUSAN ST
SANTA ANA CA
92703-3433
US

V. Phone/Fax

Practice location:
  • Phone: 714-554-8906
  • Fax: 714-554-8770
Mailing address:
  • Phone: 714-554-8906
  • Fax: 714-554-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MINDY ANDREWS
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-554-8906