Provider Demographics
NPI:1689188377
Name:WESTCARE PACIFIC ISLANDS
Entity Type:Organization
Organization Name:WESTCARE PACIFIC ISLANDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:FEJARAN
Authorized Official - Last Name:BORDALLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:671-787-7978
Mailing Address - Street 1:P.O. BOX 23873
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921
Mailing Address - Country:US
Mailing Address - Phone:671-787-7978
Mailing Address - Fax:
Practice Address - Street 1:222 CHALAN SANTO PAPA
Practice Address - Street 2:REFLECTION CENTER SUITE 102
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-472-0218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTCARE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty