Organization
PHOENIX HOUSE ORANGE COUNTY, INC.
Active
Other names
CYS Phoenix Academy of Orange County
Organization subpart
No
Provider details
NPI number
Authorized official
POURIA ABBASSI P.E. (SENIOR VP, REGIONAL DIRECTOR)
(818) 686-3011
Entity
Organization
Contact information
Practice address
1207 E FRUIT ST, SANTA ANA, CA 92701-4206
(714) 953-9373
Mailing address
1207 E FRUIT ST, SANTA ANA, CA 92701-4206
(714) 953-9373
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
300605606
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1612
LEGAL ENTITY NUMBER
CA
01
—
300605606
CA DEPT OF ALCOHOL AND DRUG PROGRAM
CA
Enumeration date
10/04/2010
Last updated
07/12/2012
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