Provider Demographics
NPI:1689181331
Name:SOUTHLAND INTEGRATED SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHLAND INTEGRATED SERVICES, INC.
Other - Org Name:INTEGRATED COMMUNITY SERVICES - WESTMINSTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:THAO
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:714-620-7007
Mailing Address - Street 1:14140 BEACH BLVD STE 223
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4453
Mailing Address - Country:US
Mailing Address - Phone:714-934-4637
Mailing Address - Fax:
Practice Address - Street 1:14140 BEACH BLVD STE 223
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4453
Practice Address - Country:US
Practice Address - Phone:714-934-4637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)