Provider Demographics
NPI:1922142504
Name:ASPIRA FOSTER & FAMILY SERVICES - FAIRFIELD
Entity Type:Organization
Organization Name:ASPIRA FOSTER & FAMILY SERVICES - FAIRFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-866-4080
Mailing Address - Street 1:324 CAMPUS LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1403
Mailing Address - Country:US
Mailing Address - Phone:707-863-7250
Mailing Address - Fax:707-863-7256
Practice Address - Street 1:324 CAMPUS LN
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1403
Practice Address - Country:US
Practice Address - Phone:707-863-7250
Practice Address - Fax:707-863-7256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOSS BEACH HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health