Provider Demographics
NPI:1407248297
Name:KNOTTS FAMILY AGENCY
Entity Type:Organization
Organization Name:KNOTTS FAMILY AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-880-0600
Mailing Address - Street 1:1505 W HIGHLAND AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1253
Mailing Address - Country:US
Mailing Address - Phone:909-880-0600
Mailing Address - Fax:909-473-1918
Practice Address - Street 1:1505 W HIGHLAND AVE STE 17
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1253
Practice Address - Country:US
Practice Address - Phone:909-880-0600
Practice Address - Fax:909-473-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366408258253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency