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 |