Healthcare Provider Details

I. General information

NPI: 1760519219
Provider Name (Legal Business Name): CHILDNET YOUTH AND FAMILY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 LONG BEACH BLVD
LONG BEACH CA
90807-3941
US

IV. Provider business mailing address

3545 LONG BEACH BLVD FL 5
LONG BEACH CA
90807-3968
US

V. Phone/Fax

Practice location:
  • Phone: 562-490-7600
  • Fax: 562-490-7601
Mailing address:
  • Phone: 562-498-5500
  • Fax: 562-498-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. WENDY FIES
Title or Position: CFO
Credential: MBA
Phone: 562-498-5513