MEDICARE: SOUTH COAST CHILDREN'S SOCIETY, 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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1447149836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COAST CHILDREN'S SOCIETY, INC

Provider Business Mailing Address
First Line	:	25910 ACERO STE 160
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-2777
Country	:	US
Telephone Number	:	714-966-8650
Fax Number	:	714-428-3102

Provider Business Practice Location Address
First Line	:	11780 CENTRAL AVE STE 205
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-6499
Country	:	US
Telephone Number	:	877-527-7227
Fax Number	:	909-364-9788

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ELLEN MAE MCGUIRK
Credential	:
Telephone Number	:	714-966-8650

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/18/2026

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