Provider Demographics
NPI:1477023265
Name:HILLSIDES
Entity Type:Organization
Organization Name:HILLSIDES
Other - Org Name:HILLSIDES YMO PEER RESOURCE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-543-2800
Mailing Address - Street 1:456 E ORANGE GROVE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-5235
Mailing Address - Country:US
Mailing Address - Phone:626-765-6010
Mailing Address - Fax:626-765-6957
Practice Address - Street 1:456 E. ORANGE GROVE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-5235
Practice Address - Country:US
Practice Address - Phone:626-765-6010
Practice Address - Fax:626-765-6957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)