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General NPI Number Information
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NPI Number | 1053021113
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Entity Type | Organization
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Legal Business Name | COLETTE'S CHILDREN HOME
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 7372 PRINCE DR STE 106
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-4574
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Country | US
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Telephone | 714-596-1380
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Fax |
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Provider Business Mailing Address
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Address Line | 7372 PRINCE DR STE 106
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-4574
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Country | US
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Telephone | 714-596-1380
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | WILLIAM O'CONNELL
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Credential |
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Telephone | 714-596-1380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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