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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
1101YA0400XAddiction (Substance Use Disorder) Counselor300605606CA
2324500000XSubstance Abuse Rehabilitation Facility300033CNCA
33245S0500XChildren's Substance Abuse Rehabilitation Facility300605606CA
4324500000XSubstance Abuse Rehabilitation Facility300033ANCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300605606OTHERCASTATE LICENSE NUMBER- ADP
21612OTHERCACALIFORNIA
38047OTHERCADRUG MEDI-CAL PROVIDER NUMB

General Provider Information

NPI Number : 1295812626
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHOENIX HOUSE ORANGE COUNTY, INC.
Provider Business Mailing Address
First Line : 11600 ELDRIDGE AVE
Second Line :
City : LAKE VIEW TERRACE
State : CA
Zip : 91342-6506
Country : US
Telephone Number : 818-686-3000
Fax Number : 818-896-4859
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 : 714-953-7573
Authorized Official
Title or Position : SENIOR VICE PRESIDENT & EXECUTIVE D
Name : MS. SHAWNA RENEE MORRIS
Credential :
Telephone Number : 818-686-3011
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/21/2022

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

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