Healthcare Provider Details

I. General information

NPI: 1780178756
Provider Name (Legal Business Name): MCKINLEY CHILDREN'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 E PALMDALE BLVD
PALMDALE CA
93550-1326
US

IV. Provider business mailing address

762 CYPRESS ST
SAN DIMAS CA
91773-3505
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-1227
  • Fax: 661-272-3830
Mailing address:
  • Phone: 909-599-1227
  • Fax: 909-670-1584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANIL VADAPARTY
Title or Position: CEO
Credential: SPHR, ESQ.
Phone: 909-599-1227