Provider Demographics
NPI:1659822179
Name:INSTITUTE FOR FAMILY CENTERED SERVICES INC
Entity Type:Organization
Organization Name:INSTITUTE FOR FAMILY CENTERED SERVICES INC
Other - Org Name:CA MENTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RISOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-740-6803
Mailing Address - Street 1:9166 ANAHEIM PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8541
Mailing Address - Country:US
Mailing Address - Phone:909-483-2505
Mailing Address - Fax:909-483-2119
Practice Address - Street 1:9166 ANAHEIM PL
Practice Address - Street 2:SUITE 200
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8541
Practice Address - Country:US
Practice Address - Phone:909-483-2505
Practice Address - Fax:909-483-2119
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL MENTOR HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health