Provider Demographics
NPI:1942385224
Name:THC - ORANGE COUNTY LLC
Entity type:Organization
Organization Name:THC - ORANGE COUNTY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-6063
Mailing Address - Street 1:845 N LARK ELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1069
Mailing Address - Country:US
Mailing Address - Phone:626-339-5451
Mailing Address - Fax:626-967-3809
Practice Address - Street 1:845 N LARK ELLEN AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791
Practice Address - Country:US
Practice Address - Phone:626-339-5451
Practice Address - Fax:626-967-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000084282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954494847OtherGREAT WEST
CA954494847OtherHUMANA
CA954494847OtherHEALTH NET
CAHSP32028FMedicaid
CA954494847OtherKAISER PERMENENTE
CA954494848OtherTRICARE/CHAMPUS
CA954494847OtherPACIFICARE
CA954494847OtherUNITED HEALTHCARE
CA954494847OtherCIGNA
CA954494847OtherAETNA
CA954494847OtherSECURE HORIZONS
CAZZZB1900ZOtherBLUE CROSS
CA=========OtherGREAT WEST