Provider Demographics
NPI:1154081867
Name:PHOENIX HOUSE ORANGE COUNTY, INC.
Entity Type:Organization
Organization Name:PHOENIX HOUSE ORANGE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF PLANNING
Authorized Official - Prefix:
Authorized Official - First Name:MAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROCHIMCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-686-3112
Mailing Address - Street 1:11600 ELDRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:91342-6506
Mailing Address - Country:US
Mailing Address - Phone:818-686-3112
Mailing Address - Fax:818-897-1293
Practice Address - Street 1:1901 E 4TH ST STE 350
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3908
Practice Address - Country:US
Practice Address - Phone:714-486-0940
Practice Address - Fax:714-546-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care