Provider Demographics
NPI:1508111097
Name:FRED FINCH YOUTH CENTER
Entity Type:Organization
Organization Name:FRED FINCH YOUTH CENTER
Other - Org Name:FRED FINCH YOUTH CENTER -WRAP #4
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-482-2244
Mailing Address - Street 1:637 3RD AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5707
Mailing Address - Country:US
Mailing Address - Phone:619-873-4075
Mailing Address - Fax:619-621-2268
Practice Address - Street 1:637 3RD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5707
Practice Address - Country:US
Practice Address - Phone:619-873-4075
Practice Address - Fax:619-621-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty