Provider Demographics
NPI: | 1710439559 |
---|---|
Name: | FRED FINCH YOUTH CENTER CARES |
Entity Type: | Organization |
Organization Name: | FRED FINCH YOUTH CENTER CARES |
Other - Org Name: | FRED FINCH YOUTH CENTER CARES-MAIN OFFICE |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | BUSINESS DEVELOPMENT ANALYST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KRISTEN |
Authorized Official - Middle Name: | LYNNE |
Authorized Official - Last Name: | MURPHY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 619-797-1090 |
Mailing Address - Street 1: | 8787 COMPLEX DR STE 300 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN DIEGO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92123-1453 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 619-797-1090 |
Mailing Address - Fax: | 858-444-8827 |
Practice Address - Street 1: | 8787 COMPLEX DR STE 300 |
Practice Address - Street 2: | |
Practice Address - City: | SAN DIEGO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92123-1453 |
Practice Address - Country: | US |
Practice Address - Phone: | 619-797-1090 |
Practice Address - Fax: | 858-444-8827 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-10-27 |
Last Update Date: | 2022-08-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Single Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Single Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Single Specialty | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty | |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Single Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Single Specialty |
No | 221700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | Group - Single Specialty | |
No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | Group - Single Specialty | |
No | 225800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Recreation Therapist | Group - Single Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Single Specialty |