Healthcare Provider Details

I. General information

NPI: 1215204201
Provider Name (Legal Business Name): SOUTH COAST CHILDREN'S SOCIETY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1461 E COOLEY DR SUITE 100
COLTON CA
92324-3921
US

IV. Provider business mailing address

25910 ACERO STE 160
MISSION VIEJO CA
92691-2777
US

V. Phone/Fax

Practice location:
  • Phone: 909-809-7337
  • Fax:
Mailing address:
  • Phone: 909-980-7000
  • Fax: 909-547-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHLEEN DARLING
Title or Position: COO
Credential:
Phone: 909-838-4274