Provider Demographics
NPI:1619233707
Name:BAYFRONT YOUTH AND FAMILY SERVICES - RESIDENTIAL TREATMENT PROGRAM
Entity Type:Organization
Organization Name:BAYFRONT YOUTH AND FAMILY SERVICES - RESIDENTIAL TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERST
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-719-9250
Mailing Address - Street 1:324 E BIXBY RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3432
Mailing Address - Country:US
Mailing Address - Phone:562-595-8111
Mailing Address - Fax:
Practice Address - Street 1:4151 FOUNTAIN STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3023
Practice Address - Country:US
Practice Address - Phone:562-719-9250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children