Healthcare Provider Details

I. General information

NPI: 1457485062
Provider Name (Legal Business Name): THE CHILDREN'S CENTER OF THE ANTELOPE VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45111 FERN AVE
LANCASTER CA
93534-2301
US

IV. Provider business mailing address

45111 FERN AVE
LANCASTER CA
93534-2301
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-1206
  • Fax: 661-940-5452
Mailing address:
  • Phone: 661-949-1206
  • Fax: 661-940-5452

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: REBECCA SUE PAGE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 661-949-1206