Healthcare Provider Details

I. General information

NPI: 1962824649
Provider Name (Legal Business Name): PROVIDENCE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18000 STUDEBAKER RD SUITE 700
CERRITOS CA
90703-2679
US

IV. Provider business mailing address

4281 KATELLA AVE SUITE 201
LOS ALAMITOS CA
90720-3500
US

V. Phone/Fax

Practice location:
  • Phone: 562-467-5577
  • Fax: 562-467-5553
Mailing address:
  • Phone: 562-467-5577
  • Fax: 562-467-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name: MICHELLE MOLNAR
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 562-467-5577