Provider Demographics
NPI:1457485062
Name:THE CHILDREN'S CENTER OF THE ANTELOPE VALLEY
Entity Type:Organization
Organization Name:THE CHILDREN'S CENTER OF THE ANTELOPE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-949-1206
Mailing Address - Street 1:45111 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2301
Mailing Address - Country:US
Mailing Address - Phone:661-949-1206
Mailing Address - Fax:661-940-5452
Practice Address - Street 1:45111 FERN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2301
Practice Address - Country:US
Practice Address - Phone:661-949-1206
Practice Address - Fax:661-940-5452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01258806Medicare UPIN