Provider Demographics
NPI:1225351828
Name:WALDEN ENVIRONMENT
Entity Type:Organization
Organization Name:WALDEN ENVIRONMENT
Other - Org Name:WALDEN FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:951-204-8299
Mailing Address - Street 1:8525 GIBBS DR.
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:619-584-5777
Mailing Address - Fax:619-584-5757
Practice Address - Street 1:255 N D ST.
Practice Address - Street 2:SUITE #412, 408
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1735
Practice Address - Country:US
Practice Address - Phone:951-788-5905
Practice Address - Fax:951-788-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health