Provider Demographics
NPI:1841382736
Name:FLORENCE CRITTENTON SERVICES OF ORANGE COUNTY, INC.
Entity Type:Organization
Organization Name:FLORENCE CRITTENTON SERVICES OF ORANGE COUNTY, INC.
Other - Org Name:CRITTENTON SERVICES FOR CHILDREN & FAMILIES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MANFRED
Authorized Official - Middle Name:FRITZ
Authorized Official - Last Name:CZYPULL
Authorized Official - Suffix:
Authorized Official - Credentials:MIM
Authorized Official - Phone:714-680-8268
Mailing Address - Street 1:801 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3839
Mailing Address - Country:US
Mailing Address - Phone:714-680-8268
Mailing Address - Fax:714-680-8207
Practice Address - Street 1:801 E CHAPMAN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3839
Practice Address - Country:US
Practice Address - Phone:714-680-8268
Practice Address - Fax:714-680-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300612972322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300612972OtherDSS FACILITY LICENSE
CA7605OtherMEDICAL CERTIFICATION LB
CA7518OtherMEDICAL CERTIFICATION C.
CA7554OtherMEDICAL CERTIFICATION B
CA306099612OtherDSS FACILITY LICENSE
CA7523OtherMEDICAL CERTIFICATION H
CA7524OtherMEDICAL CERTIFICATION VV
CA00870OtherMH LEGAL ENTITY
CA300600336OtherDSS FACILITY LICENSE