Provider Demographics
NPI:1497882161
Name:SOUTH COAST CHILDREN'S SOCIETY, INC.
Entity Type:Organization
Organization Name:SOUTH COAST CHILDREN'S SOCIETY, INC.
Other - Org Name:CYS SOUTH COAST CHILDREN'S SOCIETY WRAPAROUND
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-244-5757
Mailing Address - Street 1:25910 ACERO STE 160
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2777
Mailing Address - Country:US
Mailing Address - Phone:909-980-6700
Mailing Address - Fax:
Practice Address - Street 1:1661 N RAYMOND AVE
Practice Address - Street 2:STE 200
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1120
Practice Address - Country:US
Practice Address - Phone:714-966-8650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1707237251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30DGOtherWRAPAROUND