Provider Demographics
NPI:1386824100
Name:FOOTHILL FAMILY SERVICE
Entity Type:Organization
Organization Name:FOOTHILL FAMILY SERVICE
Other - Org Name:FOOTHILL FAMILY - PROTOTYPES
Other - Org Type:Other Name
Authorized Official - Title/Position:IT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-993-3033
Mailing Address - Street 1:2500 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3464
Mailing Address - Country:US
Mailing Address - Phone:626-993-3000
Mailing Address - Fax:626-993-3084
Practice Address - Street 1:2500 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3464
Practice Address - Country:US
Practice Address - Phone:626-564-1613
Practice Address - Fax:626-564-1651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOTHILL FAMILY SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-08
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)