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General NPI Number Information
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NPI Number | 1942385224
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Entity Type | Organization
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Legal Business Name | THC - ORANGE COUNTY LLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 845 N LARK ELLEN AVE
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City | WEST COVINA
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State | CA
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Zip | 91791
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Country | US
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Telephone | 626-339-5451
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Fax | 626-967-3809
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Provider Business Mailing Address
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Address Line | 845 N LARK ELLEN AVE
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City | WEST COVINA
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State | CA
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Zip | 91791-1069
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Country | US
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Telephone | 626-339-5451
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Fax | 626-967-3809
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOHNETTA TRAYLOR
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Credential |
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Telephone | 502-596-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number | 930000084
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License Number State | CA
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