Provider Demographics
NPI:1457574683
Name:COUNTY OF ORANGE
Entity Type:Organization
Organization Name:COUNTY OF ORANGE
Other - Org Name:BHS-SUD-AV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RAJALINGAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CHC
Authorized Official - Phone:714-834-3154
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 1:5 MAREBLU, SUITES 100, 200, AND 250
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3014
Practice Address - Country:US
Practice Address - Phone:949-643-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ORANGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-10
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8090Medicaid
CA308090OtherADP