1346791803 NPI number — FIELDS COMP. YOUTH SERVICES, INC.

Table of content: (NPI 1346791803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346791803 NPI number — FIELDS COMP. YOUTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIELDS COMP. YOUTH SERVICES, 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:
Provider Other Organization Name Type Code:
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:
1346791803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8780 19TH ST
Provider Second Line Business Mailing Address:
SUITE 196
Provider Business Mailing Address City Name:
ALTA LOMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91701-4608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-608-1991
Provider Business Mailing Address Fax Number:
909-466-4815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7062 NAPA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTA LOMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91701-5431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-466-8685
Provider Business Practice Location Address Fax Number:
909-466-4815
Provider Enumeration Date:
10/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FIELDS
Authorized Official First Name:
ARBY
Authorized Official Middle Name:
ENRICO
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
909-945-1318

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  366402086 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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