Provider Demographics
NPI:1962139212
Name:PHOENIX HOUSE ORANGE COUNTY, INC
Entity type:Organization
Organization Name:PHOENIX HOUSE ORANGE COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF PLANNING & DEVEL
Authorized Official - Prefix:
Authorized Official - First Name:MAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROCHIMCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-686-3112
Mailing Address - Street 1:11600 ELDRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:91342-6506
Mailing Address - Country:US
Mailing Address - Phone:818-384-8944
Mailing Address - Fax:818-896-4859
Practice Address - Street 1:265 S ANITA DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3355
Practice Address - Country:US
Practice Address - Phone:657-933-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No251S00000XAgenciesCommunity/Behavioral Health