MEDICARE: JOHN HENRY FOUNDATION

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	323P00000X	Psychiatric Residential Treatment Facility
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1730422676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN HENRY FOUNDATION

Provider Business Mailing Address
First Line	:	403 N SUSAN ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3433
Country	:	US
Telephone Number	:	714-554-8906
Fax Number	:	714-554-8770

Provider Business Practice Location Address
First Line	:	403 N SUSAN ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3433
Country	:	US
Telephone Number	:	714-554-8906
Fax Number	:	714-554-8770

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MINDY ANDREWS
Credential	:
Telephone Number	:	714-554-8906

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	05/16/2013

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Directions to “JOHN HENRY FOUNDATION ” Practice Location

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