Provider Demographics
NPI:1194854182
Name:FRED FINCH YOUTH CENTERS
Entity Type:Organization
Organization Name:FRED FINCH YOUTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEXLER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:619-258-4012
Mailing Address - Street 1:453 13TH ST APT 337
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7562
Mailing Address - Country:US
Mailing Address - Phone:323-687-7492
Mailing Address - Fax:
Practice Address - Street 1:10025 LOS RANCHITOS RD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-2723
Practice Address - Country:US
Practice Address - Phone:619-258-4012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities