Provider Demographics
NPI:1841519055
Name:HATHWAY SYCAMORES CHILD AND FAMILY SERVICES
Entity type:Organization
Organization Name:HATHWAY SYCAMORES CHILD AND FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JADE
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:BA LIBERAL STUDIES
Authorized Official - Phone:818-787-4151
Mailing Address - Street 1:15015 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2613
Mailing Address - Country:US
Mailing Address - Phone:818-787-4151
Mailing Address - Fax:818-787-2840
Practice Address - Street 1:2933 EL NIDO DR
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4529
Practice Address - Country:US
Practice Address - Phone:818-787-4151
Practice Address - Fax:818-787-2840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAN NUYS TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-27
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190327AP251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health