NPIMap

Organization Active NPI

Phoenix House Orange County, Inc

  • Adolescent and Children Mental Health Clinic/Center
  • Santa Ana, CA
National Provider Identifier
1225332802
Registry record updated Mar 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
PHOENIX HOUSE ORANGE COUNTY, INC
Practice address
1615 E. 17TH St
Suite #100
Santa Ana, CA 92705
Phone
(714) 955-4042
Fax
(714) 541-7924
NPI assigned
Dec 22, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Pouria Abbassi
Title
Sen. Vice President
Phone
(818) 686-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

1615 E. 17TH St
Suite #100
Santa Ana, CA 92705

Mailing address

1615 E. 17TH St
Suite #100
Santa Ana, CA 92705
Phone (714) 955-4042

Other names 1

  • CYS Phoenix Wraparound Other name

National Provider Directory

National Provider Directory
Tax ID family
Phoenix House Orange County Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1615 E 17th St
Ste 100
Santa Ana, CA 92705
Phone (714) 474-3543

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363737600000",
    "number": "1225332802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 E. 17TH ST",
            "address_2": "SUITE #100",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92705",
            "telephone_number": "714-955-4042",
            "fax_number": "714-541-7924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 E. 17TH ST",
            "address_2": "SUITE #100",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92705",
            "telephone_number": "714-955-4042",
            "fax_number": "714-541-7924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HOUSE ORANGE COUNTY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-22",
        "last_updated": "2013-03-20",
        "status": "A",
        "authorized_official_last_name": "ABBASSI",
        "authorized_official_first_name": "POURIA",
        "authorized_official_title_or_position": "SEN. VICE PRESIDENT",
        "authorized_official_telephone_number": "818-686-3000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CYS Phoenix Wraparound",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Ana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.