Provider Demographics
NPI:1740573690
Name:EASTER SEALS SOUTHERN CALIFORNIA, INC
Entity Type:Organization
Organization Name:EASTER SEALS SOUTHERN CALIFORNIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-834-1111
Mailing Address - Street 1:1801 E EDINGER AVE
Mailing Address - Street 2:STE 190
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4754
Mailing Address - Country:US
Mailing Address - Phone:714-834-1111
Mailing Address - Fax:714-834-1128
Practice Address - Street 1:500 W CENTRAL AVE
Practice Address - Street 2:STE A
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3027
Practice Address - Country:US
Practice Address - Phone:714-834-1111
Practice Address - Fax:714-834-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty