Provider Demographics
NPI:1477746824
Name:VISTA DEL MAR CHILD AND FAMILY SERVICES
Entity Type:Organization
Organization Name:VISTA DEL MAR CHILD AND FAMILY SERVICES
Other - Org Name:VISTA DEL MAR WRAPAROUND SA8
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR QUALITY, STANDARDS AND COM
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-836-1223
Mailing Address - Street 1:11222 S LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90304-1109
Mailing Address - Country:US
Mailing Address - Phone:310-836-1223
Mailing Address - Fax:310-838-6028
Practice Address - Street 1:11222 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90304-1109
Practice Address - Country:US
Practice Address - Phone:310-836-1223
Practice Address - Fax:310-838-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health