Basic Information
| Provider Information | |||||||||
| NPI: | 1659933372 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSTITUTE FOR FAMILY CENTERED SERVICES INC., DBA CALIFORNIA MENTOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3756 SANTA ROSALIA DR STE 424 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900083614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097367361 | ||||||||
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| Practice Location | |||||||||
| Address1: | 41990 COOK ST STE 801A | ||||||||
| Address2: | |||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922116103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517820040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 07/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | RISOTTI | ||||||||
| AuthorizedOfficialFirstName: | STACEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5087406803 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NATIONAL MENTOR HEALTHCARE, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.