Provider Demographics
NPI:1033262688
Name:KIDS FIRST FOUNDATION
Entity Type:Organization
Organization Name:KIDS FIRST FOUNDATION
Other - Org Name:BROAD HORIZONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT REGIONAL VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-783-8470
Mailing Address - Street 1:11980 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5172
Mailing Address - Country:US
Mailing Address - Phone:909-783-8470
Mailing Address - Fax:909-783-7762
Practice Address - Street 1:1236 H ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2837
Practice Address - Country:US
Practice Address - Phone:760-789-7060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness