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NPI Code Detail

MEDICARE: PHOENIX HOUSE ORANGE COUNTY, INC.

MEDICARE: PHOENIX HOUSE ORANGE COUNTY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13245S0500XChildren's Substance Abuse Rehabilitation Facility300605606CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300605606OTHERCACA DEPT OF ALCOHOL AND DRUG PROGRAM
21612OTHERCALEGAL ENTITY NUMBER

General Provider Information

NPI Number : 1083923429
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOENIX HOUSE ORANGE COUNTY, INC.
Provider Business Mailing Address
First Line : 1207 E FRUIT ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-4206
Country : US
Telephone Number : 714-953-9373
Fax Number :
Provider Business Practice Location Address
First Line : 1207 E FRUIT ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-4206
Country : US
Telephone Number : 714-953-9373
Fax Number :
Authorized Official
Title or Position : SENIOR VP, REGIONAL DIRECTOR
Name : POURIA ABBASSI
Credential : P.E.
Telephone Number : 818-686-3011
Provider Enumeration Date : 10/04/2010
Last Update Date : 07/12/2012

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Directions to “PHOENIX HOUSE ORANGE COUNTY, INC. ” Practice Location

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