Healthcare Provider Details

I. General information

NPI: 1093265910
Provider Name (Legal Business Name): FLEMING & BARNES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44116 63RD ST W
LANCASTER CA
93536-7567
US

IV. Provider business mailing address

PO BOX 4446
PALOS VERDES PENINSULA CA
90274-9595
US

V. Phone/Fax

Practice location:
  • Phone: 310-791-3064
  • Fax: 661-722-3176
Mailing address:
  • Phone: 310-791-3064
  • Fax: 310-791-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number197605014
License Number StateCA

VIII. Authorized Official

Name: KENNETH FLEMING
Title or Position: DIRECTOR
Credential:
Phone: 310-791-3064