Provider Demographics
NPI:1972047165
Name:HILLSIDES
Entity Type:Organization
Organization Name:HILLSIDES
Other - Org Name:BIENVENIDOS FAMILY RESOURCE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-254-2274
Mailing Address - Street 1:5400 E. OLYMPIC BLVD SUITE 100
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5190
Mailing Address - Country:US
Mailing Address - Phone:213-785-5906
Mailing Address - Fax:213-785-5928
Practice Address - Street 1:5400 E. OLYMPIC BLVD SUITE 100
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5190
Practice Address - Country:US
Practice Address - Phone:213-785-5906
Practice Address - Fax:213-785-5928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILLSIDES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-07
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health