Provider Demographics
NPI:1184766230
Name:CANYON ACRES CHILDREN AND FAMILY SERVICES
Entity type:Organization
Organization Name:CANYON ACRES CHILDREN AND FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-383-9343
Mailing Address - Street 1:1845 W ORANGEWOOD AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2051
Mailing Address - Country:US
Mailing Address - Phone:714-383-9400
Mailing Address - Fax:714-383-9243
Practice Address - Street 1:1845 W ORANGEWOOD AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2051
Practice Address - Country:US
Practice Address - Phone:714-383-9400
Practice Address - Fax:714-383-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30B2OtherMEDI-CAL BILLING PROVIDER