Provider Demographics
NPI:1790425247
Name:CENTERPOINTE FOR CHILDREN
Entity Type:Organization
Organization Name:CENTERPOINTE FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AJA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:949-474-4525
Mailing Address - Street 1:19772 MACARTHUR BLVD # 260A
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2413
Mailing Address - Country:US
Mailing Address - Phone:949-474-4525
Mailing Address - Fax:
Practice Address - Street 1:19772 MACARTHUR BLVD # 260A
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2413
Practice Address - Country:US
Practice Address - Phone:949-474-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities