Provider Demographics
NPI:1346791803
Name:FIELDS COMP. YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:FIELDS COMP. YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARBY
Authorized Official - Middle Name:ENRICO
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-945-1318
Mailing Address - Street 1:8780 19TH ST
Mailing Address - Street 2:SUITE 196
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4608
Mailing Address - Country:US
Mailing Address - Phone:909-608-1991
Mailing Address - Fax:909-466-4815
Practice Address - Street 1:7062 NAPA AVE
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-5431
Practice Address - Country:US
Practice Address - Phone:909-466-8685
Practice Address - Fax:909-466-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366402086322D00000X
322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children