Basic Information
| Provider Information | |||||||||
| NPI: | 1730447061 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPIRITT FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 TYLER AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917333543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264424788 | ||||||||
| FaxNumber: | 6264483425 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 TYLER AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917333543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264424788 | ||||||||
| FaxNumber: | 6264483425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2012 | ||||||||
| LastUpdateDate: | 04/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | TORRES | ||||||||
| AuthorizedOfficialFirstName: | ELVIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5629037000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.S., L.M.F.T. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | S0504101446 | CA | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | S0504101446 | 01 | CA | BREINING INSTITUTE | OTHER |