Provider Demographics
NPI:1851078943
Name:TEEN LEADERSHIP FOUNDATION
Entity Type:Organization
Organization Name:TEEN LEADERSHIP FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-235-9951
Mailing Address - Street 1:PO BOX 7342
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-7342
Mailing Address - Country:US
Mailing Address - Phone:714-235-9951
Mailing Address - Fax:
Practice Address - Street 1:825 TURTLE CREST DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-1008
Practice Address - Country:US
Practice Address - Phone:714-235-9951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp