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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1629429378
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	:	909-980-6700
Fax Number	:	909-547-6552

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	:	909-835-4800
Fax Number	:	909-547-6552

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	MRS. KATHLEEN DARLING
Credential	:
Telephone Number	:	909-838-4274

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	08/01/2022

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