Provider Demographics
NPI:1114503760
Name:MARY'S SHELTER
Entity Type:Organization
Organization Name:MARY'S SHELTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:CAYLEY
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:714-730-0930
Mailing Address - Street 1:18221 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2676
Mailing Address - Country:US
Mailing Address - Phone:714-730-0930
Mailing Address - Fax:
Practice Address - Street 1:18221 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-2676
Practice Address - Country:US
Practice Address - Phone:714-730-0930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY'S SHELTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children