Provider Demographics
NPI:1407993249
Name:COUNTY OF ORANGE
Entity Type:Organization
Organization Name:COUNTY OF ORANGE
Other - Org Name:CYS YOUTH REPORTING CENTER NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:SABET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CHC, CHPC
Authorized Official - Phone:714-581-7769
Mailing Address - Street 1:405 W 5TH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4522
Mailing Address - Country:US
Mailing Address - Phone:714-568-5614
Mailing Address - Fax:714-834-6595
Practice Address - Street 1:1920 W CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5373
Practice Address - Country:US
Practice Address - Phone:714-667-7610
Practice Address - Fax:714-667-7621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ORANGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30BKMedicaid
CAW5037AMedicare ID - Type Unspecified