Provider Demographics
NPI:1619257037
Name:BETHANY CHRISTIAN SERVICES OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:714-994-0500
Mailing Address - Street 1:16700 VALLEY VIEW AVE
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5830
Mailing Address - Country:US
Mailing Address - Phone:714-994-0500
Mailing Address - Fax:714-994-0515
Practice Address - Street 1:16700 VALLEY VIEW AVE
Practice Address - Street 2:SUITE # 210
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-5830
Practice Address - Country:US
Practice Address - Phone:714-994-0500
Practice Address - Fax:714-994-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197804198253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency