Basic Information
| Provider Information | |||||||||
| NPI: | 1063881894 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR INTEGRATED CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15340 DEVONSHIRE ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913452760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235380975 | ||||||||
| FaxNumber: | 8184844084 | ||||||||
| Practice Location | |||||||||
| Address1: | 15340 DEVONSHIRE ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913452760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235380975 | ||||||||
| FaxNumber: | 8184844084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2015 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHA | ||||||||
| AuthorizedOfficialFirstName: | SONYA | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8182319476 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MFC50211 | CA | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 106H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1063881894 | 05 | CA | MEDICAID | 1063881894 | 01 | CA | COMMERCIAL INSURANCE | OTHER |