Provider Demographics
NPI:1891200564
Name:COMMUNITY OPTIONS FOR FAMILIES AND YOUTH, INC
Entity Type:Organization
Organization Name:COMMUNITY OPTIONS FOR FAMILIES AND YOUTH, INC
Other - Org Name:HIGHLANDS COUNSELING ENRICHED CLASSROOMS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-943-1794
Mailing Address - Street 1:3478 BUSKIRK AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4358
Mailing Address - Country:US
Mailing Address - Phone:925-943-1794
Mailing Address - Fax:
Practice Address - Street 1:4141 HARBOR ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-6156
Practice Address - Country:US
Practice Address - Phone:925-473-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health