Healthcare Provider Details

I. General information

NPI: 1104373000
Provider Name (Legal Business Name): FIVE ACRES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 MOUNTAIN VIEW ST
ALTADENA CA
91001-4925
US

IV. Provider business mailing address

867 N FAIR OAKS AVE
PASADENA CA
91103-3083
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-6793
  • Fax: 626-792-7722
Mailing address:
  • Phone: 626-798-6793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LAUREN MCARTHUR
Title or Position: REHAB SPECIALIST
Credential:
Phone: 626-798-6793