Provider Demographics
NPI:1700270188
Name:HILLSIDES
Entity Type:Organization
Organization Name:HILLSIDES
Other - Org Name:HILLSIDES FRC POMONA
Other - Org Type:Other Name
Authorized Official - Title/Position: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:323-543-2800
Mailing Address - Street 1:1902 ROYALTY DRIVE SUITE 240 & 260
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3061
Mailing Address - Country:US
Mailing Address - Phone:909-622-3200
Mailing Address - Fax:323-978-1263
Practice Address - Street 1:1902 ROYALTY DRIVE SUITE 240 & 260
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3061
Practice Address - Country:US
Practice Address - Phone:909-622-3200
Practice Address - Fax:323-978-1263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILLSIDES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-24
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health