Provider Demographics
NPI:1275210239
Name:OC TEEN ADDICTION LLC
Entity Type:Organization
Organization Name:OC TEEN ADDICTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RUEBEN
Authorized Official - Middle Name:RAYNARD
Authorized Official - Last Name:GRAJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:BSM
Authorized Official - Phone:714-474-8655
Mailing Address - Street 1:2809 S BAKER ST APT D
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3664
Mailing Address - Country:US
Mailing Address - Phone:714-474-8655
Mailing Address - Fax:
Practice Address - Street 1:1940 W ORANGEWOOD AVE STE 206
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5037
Practice Address - Country:US
Practice Address - Phone:714-474-8655
Practice Address - Fax:949-203-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility