Provider Demographics
NPI:1417089046
Name:BIENVENIDOS CHILDREN'S CENTER, INC
Entity Type:Organization
Organization Name:BIENVENIDOS CHILDREN'S CENTER, INC
Other - Org Name:BIENVENIDOS VILLAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF PROGRAM OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:213-785-5906
Mailing Address - Street 1:501 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2621
Mailing Address - Country:US
Mailing Address - Phone:213-785-5906
Mailing Address - Fax:213-785-5928
Practice Address - Street 1:255 N SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3429
Practice Address - Country:US
Practice Address - Phone:626-696-1270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7382AMedicaid