Provider Demographics
NPI:1619323383
Name:TRINITY YOUTH SERVICES
Entity Type:Organization
Organization Name:TRINITY YOUTH SERVICES
Other - Org Name:TRINITY RANCHO CUCAMONGA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:714-713-0561
Mailing Address - Street 1:9570 CENTER AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5814
Mailing Address - Country:US
Mailing Address - Phone:909-980-4755
Mailing Address - Fax:909-980-2396
Practice Address - Street 1:9570 CENTER AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5814
Practice Address - Country:US
Practice Address - Phone:909-980-4755
Practice Address - Fax:909-980-2396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health