Healthcare Provider Details

I. General information

NPI: 1427394865
Provider Name (Legal Business Name): EASTER SEALS SOUTHERN CALIFORNIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S TOWNE CENTRE PL STE 370
ANAHEIM CA
92806-6122
US

IV. Provider business mailing address

1570 E 17TH ST
SANTA ANA CA
92705-8502
US

V. Phone/Fax

Practice location:
  • Phone: 714-922-4453
  • Fax: 714-937-1531
Mailing address:
  • Phone: 714-834-1111
  • Fax: 714-834-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SUSAN BERGLUND
Title or Position: CFO
Credential:
Phone: 714-834-1111