Provider Demographics
NPI:1043495831
Name:FRED FINCH YOUTH CTR.
Entity Type:Organization
Organization Name:FRED FINCH YOUTH CTR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSC/MA, MFTI
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MFTI
Authorized Official - Phone:570-482-2244
Mailing Address - Street 1:3800 COOLIDGE AVE.
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602
Mailing Address - Country:US
Mailing Address - Phone:510-482-2244
Mailing Address - Fax:570-485-5351
Practice Address - Street 1:3800 COOLIDGE AVE.
Practice Address - Street 2:BUILDING H
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602
Practice Address - Country:US
Practice Address - Phone:570-482-2244
Practice Address - Fax:510-485-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 53142251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health