Provider Demographics
NPI:1649747213
Name:FOOTHILL FAMILY SERVICE
Entity Type:Organization
Organization Name:FOOTHILL FAMILY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-993-3003
Mailing Address - Street 1:2500 E FOOTHILL BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7102
Mailing Address - Country:US
Mailing Address - Phone:626-993-3000
Mailing Address - Fax:626-993-3084
Practice Address - Street 1:2800 E HOLLINGWORTH ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3029
Practice Address - Country:US
Practice Address - Phone:626-993-3000
Practice Address - Fax:626-993-3084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOTHILL FAMILY SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-31
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)