Organization
PHOENIX HOUSE ORANGE COUNTY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHAWNA RENEE MORRIS (SENIOR VICE PRESIDENT & EXECUTIVE D)
(818) 686-3011
Entity
Organization
Contact information
Practice address
1207 E FRUIT ST, SANTA ANA, CA 92701-4206
(714) 953-9373
(714) 953-7573
Mailing address
11600 ELDRIDGE AVE, LAKE VIEW TERRACE, CA 91342-6506
(818) 686-3000
(818) 896-4859
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
300605606
CA
324500000X
Substance Abuse Rehabilitation Facility
Primary
300033AN
CA
324500000X
Substance Abuse Rehabilitation Facility
300033CN
CA
3245S0500X
Children's Substance Abuse Rehabilitation Facility
300605606
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1612
CALIFORNIA
CA
01
—
300605606
STATE LICENSE NUMBER- ADP
CA
01
—
8047
DRUG MEDI-CAL PROVIDER NUMB
CA
Enumeration date
11/01/2006
Last updated
07/21/2022
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