Provider Demographics
NPI:1083262513
Name:D'VEAL FAMILY AND YOUTH SERVICES
Entity Type:Organization
Organization Name:D'VEAL FAMILY AND YOUTH SERVICES
Other - Org Name:DFYS GLENDORA HIGH SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR MIS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-296-8900
Mailing Address - Street 1:2750 E WASHINGTON BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1449
Mailing Address - Country:US
Mailing Address - Phone:626-296-8900
Mailing Address - Fax:
Practice Address - Street 1:1600 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3024
Practice Address - Country:US
Practice Address - Phone:626-963-5731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:D'VEAL FAMILY AND YOUTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health