Provider Demographics
NPI:1164767141
Name:SOUTHERN CALIFORNIA INDIAN CENTER
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA INDIAN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-662-6673
Mailing Address - Street 1:10175 SLATER AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4717
Mailing Address - Country:US
Mailing Address - Phone:714-962-6673
Mailing Address - Fax:
Practice Address - Street 1:5805 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:CA
Practice Address - Zip Code:90042-4227
Practice Address - Country:US
Practice Address - Phone:323-274-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency