Provider Demographics
NPI:1245400670
Name:GREAT EXPECTATIONS SERVICES INC
Entity Type:Organization
Organization Name:GREAT EXPECTATIONS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:714-812-8684
Mailing Address - Street 1:555 N EL CAMINO REAL
Mailing Address - Street 2:SUITE A432
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6740
Mailing Address - Country:US
Mailing Address - Phone:714-812-8684
Mailing Address - Fax:949-218-1670
Practice Address - Street 1:822 GRANADA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-4733
Practice Address - Country:US
Practice Address - Phone:714-812-8684
Practice Address - Fax:949-218-1670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT EXPECTATIONS SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities