Provider Demographics
NPI: | 1104963347 |
---|---|
Name: | COUNTY OF ORANGE |
Entity type: | Organization |
Organization Name: | COUNTY OF ORANGE |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF COMPLIANCE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KELLY |
Authorized Official - Middle Name: | KATHLEEN |
Authorized Official - Last Name: | SABET |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW, CHC,CHPC,CHRC |
Authorized Official - Phone: | 714-581-7769 |
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: | |
Practice Address - Street 1: | 405 W 5TH ST STE 212 |
Practice Address - Street 2: | |
Practice Address - City: | SANTA ANA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92701-4522 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-568-5614 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | COUNTY OF ORANGE |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-01-30 |
Last Update Date: | 2024-11-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No | 291U00000X | Laboratories | Clinical Medical Laboratory | |
No | 251B00000X | Agencies | Case Management | |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No | 261QP0905X | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local |
No | 313M00000X | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | W5037A | Medicare PIN |