Basic Information
| Provider Information | |||||||||
| NPI: | 1427188424 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR INTEGRATED FAMILY AND HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 536 S 2ND AVE STE D | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917233043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269661577 | ||||||||
| FaxNumber: | 6263314529 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 S EREMLAND DR STE A-E | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917233186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269661577 | ||||||||
| FaxNumber: | 6263314529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | NIGH | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6269661577 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7545A | 01 | CA | DMH | OTHER |