Provider Demographics
NPI:1336201490
Name:NEW HAVEN YOUTH & FAMILY SERVICES, INC
Entity Type:Organization
Organization Name:NEW HAVEN YOUTH & FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-630-4035
Mailing Address - Street 1:PO BOX 1199
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92085-1199
Mailing Address - Country:US
Mailing Address - Phone:760-630-4035
Mailing Address - Fax:760-630-4030
Practice Address - Street 1:216 W LOS ANGELES DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-3101
Practice Address - Country:US
Practice Address - Phone:760-630-4035
Practice Address - Fax:760-630-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33EJO1251B00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33EJO1Medicare ID - Type Unspecified
CA33G501Medicare ID - Type Unspecified