Provider Demographics
NPI:1295514149
Name:FIELDS COMP. YOUTH SERVICES INC.
Entity type:Organization
Organization Name:FIELDS COMP. YOUTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARBY
Authorized Official - Middle Name:ENRICO
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-322-6980
Mailing Address - Street 1:8780 19TH ST # 196
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4608
Mailing Address - Country:US
Mailing Address - Phone:909-322-6980
Mailing Address - Fax:909-466-4815
Practice Address - Street 1:2390 PORTOLA ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-6930
Practice Address - Country:US
Practice Address - Phone:909-376-4148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIELDS COMP. YOUTH SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children