Basic Information
| Provider Information | |||||||||
| NPI: | 1427185917 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHILDNET YOUTH AND FAMILY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5150 E PACIFIC COAST HWY STE 365 | ||||||||
| Address2: | PO BOX 4550 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908043323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624985500 | ||||||||
| FaxNumber: | 5624985589 | ||||||||
| Practice Location | |||||||||
| Address1: | 4151 E FOUNTAIN ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908043023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629616100 | ||||||||
| FaxNumber: | 5629616363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GREENBERG | ||||||||
| AuthorizedOfficialFirstName: | ALLAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5624985507 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.