Provider Demographics
NPI:1437714631
Name:MITCHELL BOYS HOME INC
Entity Type:Organization
Organization Name:MITCHELL BOYS HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BOMTEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-804-0476
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91003-0002
Mailing Address - Country:US
Mailing Address - Phone:323-804-0476
Mailing Address - Fax:866-250-9117
Practice Address - Street 1:43728 22ND ST E
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-5650
Practice Address - Country:US
Practice Address - Phone:323-804-0476
Practice Address - Fax:866-250-9117
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MITCHELL BOYS HOME INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health