Provider Demographics
NPI:1366828246
Name:ORANGE COUNTY RECOVERY
Entity Type:Organization
Organization Name:ORANGE COUNTY RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CDAAC, CATC L
Authorized Official - Phone:714-313-8302
Mailing Address - Street 1:18632 BEACH BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2045
Mailing Address - Country:US
Mailing Address - Phone:714-313-8302
Mailing Address - Fax:
Practice Address - Street 1:18632 BEACH BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2045
Practice Address - Country:US
Practice Address - Phone:714-313-8302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300321AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility