Basic Information
| Provider Information | |||||||||
| NPI: | 1417159583 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MCKINLEY CHILDREN'S CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MCKINLEY CHILDREN'S CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 762 WEST CYPRESS STREET | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917733505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095991227 | ||||||||
| FaxNumber: | 9095923841 | ||||||||
| Practice Location | |||||||||
| Address1: | 762 WEST CYPRESS STREET | ||||||||
| Address2: | |||||||||
| City: | SAN DIMAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917733505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095991227 | ||||||||
| FaxNumber: | 9095923841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | VADAPARTY | ||||||||
| AuthorizedOfficialFirstName: | ANIL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9095991227 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | SPHR, ESQ. | ||||||||
| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 191502075 | CA | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 251S00000X | 191502075 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.