Provider Demographics
NPI:1609384551
Name:CHILDNET YOUTH AND FAMILY SERVICES INC
Entity Type:Organization
Organization Name:CHILDNET YOUTH AND FAMILY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FIES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-498-5513
Mailing Address - Street 1:3545 LONG BEACH BLVD FL 5
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3968
Mailing Address - Country:US
Mailing Address - Phone:562-498-5500
Mailing Address - Fax:
Practice Address - Street 1:2131 MARS CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6830
Practice Address - Country:US
Practice Address - Phone:661-633-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDNET YOUTH AND FAMILY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-12
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0801X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)