Provider Demographics
NPI:1225332802
Name:PHOENIX HOUSE ORANGE COUNTY, INC
Entity Type:Organization
Organization Name:PHOENIX HOUSE ORANGE COUNTY, INC
Other - Org Name:CYS PHOENIX WRAPAROUND
Other - Org Type:Other Name
Authorized Official - Title/Position:SEN. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:POURIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-686-3000
Mailing Address - Street 1:1615 E. 17TH ST
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-955-4042
Mailing Address - Fax:714-541-7924
Practice Address - Street 1:1615 E. 17TH ST
Practice Address - Street 2:SUITE #100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-955-4042
Practice Address - Fax:714-541-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health