Provider Demographics
NPI:1053021113
Name:COLETTE'S CHILDREN HOME
Entity type:Organization
Organization Name:COLETTE'S CHILDREN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-596-1380
Mailing Address - Street 1:7372 PRINCE DR STE 106
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4574
Mailing Address - Country:US
Mailing Address - Phone:714-596-1380
Mailing Address - Fax:
Practice Address - Street 1:7372 PRINCE DR STE 106
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4574
Practice Address - Country:US
Practice Address - Phone:714-596-1380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
No305S00000XManaged Care OrganizationsPoint of Service