Healthcare Provider Details

I. General information

NPI: 1851078943
Provider Name (Legal Business Name): TEEN LEADERSHIP FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 TURTLE CREST DR
IRVINE CA
92603-1008
US

IV. Provider business mailing address

PO BOX 7342
NEWPORT BEACH CA
92658-7342
US

V. Phone/Fax

Practice location:
  • Phone: 714-235-9951
  • Fax:
Mailing address:
  • Phone: 714-235-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA R CASTETTER
Title or Position: FOUNDER & CEO
Credential:
Phone: 714-235-9951