Healthcare Provider Details

I. General information

NPI: 1083158810
Provider Name (Legal Business Name): HILLSIDES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 RAMONA BLVD. SUITE A
IRWINDALE CA
91706-3752
US

IV. Provider business mailing address

13001 RAMONA BLVD. SUITE A
IRWINDALE CA
91706-3752
US

V. Phone/Fax

Practice location:
  • Phone: 323-274-3075
  • Fax: 626-798-7899
Mailing address:
  • Phone: 626-373-2900
  • Fax: 626-798-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACEY ROTH
Title or Position: CEO
Credential: LCSW
Phone: 323-254-2274