1962634956 NPI number — SOUTH COAST CHILDREN'S SOCIETY, INC

Table of content: (NPI 1255380663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962634956 NPI number — SOUTH COAST CHILDREN'S SOCIETY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH COAST CHILDREN'S SOCIETY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH COAST COMMUNITY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962634956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25910 ACERO STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-2777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-980-7000
Provider Business Mailing Address Fax Number:
909-547-6552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34324 YUCAIPA BLVD
Provider Second Line Business Practice Location Address:
SUITE B-D
Provider Business Practice Location Address City Name:
YUCAIPA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92399-2496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-790-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DARLING
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATIONS OFFICER
Authorized Official Telephone Number:
909-838-4274

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36EQ , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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