1730067927 NPI number — BEHAVIORAL ASSESSMENT CENTER OF SOUTH ORANGE COUNTY

Table of content: (NPI 1730067927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730067927 NPI number — BEHAVIORAL ASSESSMENT CENTER OF SOUTH ORANGE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL ASSESSMENT CENTER OF SOUTH ORANGE COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730067927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14292 CULVER DR
Provider Second Line Business Mailing Address:
920
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-462-9114
Provider Business Mailing Address Fax Number:
949-460-9114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24800 CHRISANTA DR STE 260
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-4837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-462-9114
Provider Business Practice Location Address Fax Number:
949-460-9114
Provider Enumeration Date:
08/25/2025

Additional Information

Authorized Official

Authorized Official Last Name:
KENNEDY
Authorized Official First Name:
ADRIENNE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SPECAILIST
Authorized Official Telephone Number:
949-426-9114

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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