Provider Demographics
NPI:1912037060
Name:SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:SAN FERNANDO VALLEY COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:SFV EAST VALLEY CMHC-MCDONALD CAREY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-901-4830
Mailing Address - Street 1:16360 ROSCOE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-1219
Mailing Address - Country:US
Mailing Address - Phone:818-901-4830
Mailing Address - Fax:818-785-3446
Practice Address - Street 1:11631 VICTORY BLVD
Practice Address - Street 2:#203
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3572
Practice Address - Country:US
Practice Address - Phone:818-908-3855
Practice Address - Fax:818-753-5265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD05914832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000007177OtherMEDICAL PROVIDER