Healthcare Provider Details

I. General information

NPI: 1942385224
Provider Name (Legal Business Name): THC - ORANGE COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N LARK ELLEN AVE
WEST COVINA CA
91791
US

IV. Provider business mailing address

845 N LARK ELLEN AVE
WEST COVINA CA
91791-1069
US

V. Phone/Fax

Practice location:
  • Phone: 626-339-5451
  • Fax: 626-967-3809
Mailing address:
  • Phone: 626-339-5451
  • Fax: 626-967-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number930000084
License Number StateCA

VIII. Authorized Official

Name: JOHNETTA TRAYLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 502-596-6063