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General NPI Number Information
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NPI Number | 1629132329
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Entity Type | Organization
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Legal Business Name | ORANGE COUNTY HALFWAY HOUSE, INC.
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12702 JOSEPHINE ST
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4668
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Country | US
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Telephone | 714-636-8222
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Fax | 714-636-0831
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Provider Business Mailing Address
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Address Line | 1415 E 17TH ST SUITE 100
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City | SANTA ANA
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State | CA
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Zip | 92705-8525
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Country | US
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Telephone | 714-543-8468
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Fax | 714-543-1064
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SOO E. KANG
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Credential | M.A.
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Telephone | 714-543-8468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 300160AN
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License Number State | CA
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