Provider Demographics
NPI:1083044044
Name:ORANGE COUNTY REHAB
Entity Type:Organization
Organization Name:ORANGE COUNTY REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-200-7924
Mailing Address - Street 1:552 HAMILTON ST UNIT E1
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5502
Mailing Address - Country:US
Mailing Address - Phone:949-200-7924
Mailing Address - Fax:866-703-9903
Practice Address - Street 1:546 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2617
Practice Address - Country:US
Practice Address - Phone:949-200-7924
Practice Address - Fax:866-703-9903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORANGE COUNTY DETOX, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300169BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility