Provider Demographics
NPI:1578801510
Name:THE VILLAGE FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:THE VILLAGE FAMILY SERVICES, INC.
Other - Org Name:THE VILLAGE FAMILY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SR. DIRECTOR COMPLIANCE & RISK MGMT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-755-8786
Mailing Address - Street 1:6736 LAUREL CANYON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1576
Mailing Address - Country:US
Mailing Address - Phone:818-755-8786
Mailing Address - Fax:323-277-4761
Practice Address - Street 1:6728 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4804
Practice Address - Country:US
Practice Address - Phone:323-277-4752
Practice Address - Fax:323-277-4761
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE VILLAGE FAMILY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-25
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197805014251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health