Provider Demographics
NPI:1609075993
Name:FAMILY PRESERVATION COMMUNITY SERVICES
Entity Type:Organization
Organization Name:FAMILY PRESERVATION COMMUNITY SERVICES
Other - Org Name:CYS FAMILY PRESERVATION COMMUNITY SERVICES WRAPAROUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-399-1860
Mailing Address - Street 1:2112 EAST 4TH STREET
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-399-1860
Mailing Address - Fax:714-399-1867
Practice Address - Street 1:2112 EAST 4TH STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-399-1860
Practice Address - Fax:714-399-1867
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PRESERVATION COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-16
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPROVIDER # 30EBOtherMEDI-CAL