Healthcare Provider Details

I. General information

NPI: 1841353166
Provider Name (Legal Business Name): FRED FINCH YOUTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10025 LOS RANCHITOS RD
LAKESIDE CA
92040-2723
US

IV. Provider business mailing address

8453 SUNRISE AVE
LA MESA CA
91941-5523
US

V. Phone/Fax

Practice location:
  • Phone: 619-258-4012
  • Fax:
Mailing address:
  • Phone: 619-741-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15804
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN STEINFIRST
Title or Position: CEO-PRESIDENT
Credential: LCSW
Phone: 510-482-2244