Provider Demographics
NPI:1932767381
Name:INTERFAITH COMMUNITY SERVICES
Entity Type:Organization
Organization Name:INTERFAITH COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:760-546-8870
Mailing Address - Street 1:1820 S ESCONDIDO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6535
Mailing Address - Country:US
Mailing Address - Phone:760-546-8870
Mailing Address - Fax:
Practice Address - Street 1:250 N ASH ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-3026
Practice Address - Country:US
Practice Address - Phone:760-546-8870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health