Basic Information
| Provider Information | |||||||||
| NPI: | 1609384551 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDNET YOUTH AND FAMILY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4155 OUTER TRAFFIC CIR | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908042111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624985500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4101 EASTON DR | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933091021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616331700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2018 | ||||||||
| LastUpdateDate: | 01/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | FIES | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 5624985513 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHILDNET YOUTH AND FAMILY SERVICES INC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.