Provider Demographics
NPI:1851614457
Name:WALDEN ENVIRONMENT
Entity Type:Organization
Organization Name:WALDEN ENVIRONMENT
Other - Org Name:WALDEN FAMILY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF QUALITY ASSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-801-7140
Mailing Address - Street 1:3576 ARLINGTON AVE
Mailing Address - Street 2:106
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3943
Mailing Address - Country:US
Mailing Address - Phone:619-584-5777
Mailing Address - Fax:619-584-5760
Practice Address - Street 1:3576 ARLINGTON AVE
Practice Address - Street 2:106
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3943
Practice Address - Country:US
Practice Address - Phone:619-584-5777
Practice Address - Fax:619-584-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336403491253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency