Provider Demographics
NPI:1346460672
Name:TOTAL FAMILY SUPPORT CLINIC
Entity Type:Organization
Organization Name:TOTAL FAMILY SUPPORT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKARLATO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-833-9789
Mailing Address - Street 1:2511 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-3111
Mailing Address - Country:US
Mailing Address - Phone:562-981-1501
Mailing Address - Fax:562-981-1502
Practice Address - Street 1:2511 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3111
Practice Address - Country:US
Practice Address - Phone:562-981-1501
Practice Address - Fax:562-981-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19-6834Medicaid
CA19-7134Medicaid