Provider Demographics
NPI:1457547317
Name:INTERFACE CHILDREN FAMILY SERVICE
Entity Type:Organization
Organization Name:INTERFACE CHILDREN FAMILY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-485-6114
Mailing Address - Street 1:4001 MISSION OAKS BLVD., SUITE I
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5121
Mailing Address - Country:US
Mailing Address - Phone:805-485-6114
Mailing Address - Fax:
Practice Address - Street 1:4001 MISSION OAKS BLVD.
Practice Address - Street 2:SUITE I
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5121
Practice Address - Country:US
Practice Address - Phone:805-485-6114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health