Provider Demographics
NPI:1518592583
Name:SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:YOUTH CONTACT BIRM HS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-901-4830
Mailing Address - Street 1:16360 ROSCOE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-1213
Mailing Address - Country:US
Mailing Address - Phone:818-901-4830
Mailing Address - Fax:
Practice Address - Street 1:17000 HAYNES ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5420
Practice Address - Country:US
Practice Address - Phone:818-908-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty