Provider Demographics
NPI:1376995530
Name:INSTITUTE FOR FAMILY CENTERED SERVICES INC.
Entity Type:Organization
Organization Name:INSTITUTE FOR FAMILY CENTERED SERVICES INC.
Other - Org Name:CA MENTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RISOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-740-6803
Mailing Address - Street 1:9166 ANAHEIM PL STE 200
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8547
Mailing Address - Country:US
Mailing Address - Phone:909-736-7361
Mailing Address - Fax:
Practice Address - Street 1:12631 IMPERIAL HWY
Practice Address - Street 2:C103
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4710
Practice Address - Country:US
Practice Address - Phone:909-736-7361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL MENTOR HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-11
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health