1841382736 NPI number — FLORENCE CRITTENTON SERVICES OF ORANGE COUNTY, INC.

Table of content: (NPI 1841382736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841382736 NPI number — FLORENCE CRITTENTON SERVICES OF ORANGE COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORENCE CRITTENTON SERVICES OF ORANGE COUNTY, INC.
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:
6
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:
1841382736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 E CHAPMAN AVE
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92831-3839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-680-8268
Provider Business Mailing Address Fax Number:
714-680-8207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E CHAPMAN AVE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92831-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-680-8268
Provider Business Practice Location Address Fax Number:
714-680-8207
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CZYPULL
Authorized Official First Name:
MANFRED
Authorized Official Middle Name:
FRITZ
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
714-680-8268

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  300612972 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300612972 . This is a "DSS FACILITY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7605 . This is a "MEDICAL CERTIFICATION LB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7518 . This is a "MEDICAL CERTIFICATION C." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7554 . This is a "MEDICAL CERTIFICATION B" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 306099612 . This is a "DSS FACILITY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7523 . This is a "MEDICAL CERTIFICATION H" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 7524 . This is a "MEDICAL CERTIFICATION VV" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00870 . This is a "MH LEGAL ENTITY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 300600336 . This is a "DSS FACILITY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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