Healthcare Provider Details

I. General information

NPI: 1316073620
Provider Name (Legal Business Name): FOOTHILL FAMILY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 GRANITE DR
PASADENA CA
91101-3501
US

IV. Provider business mailing address

2500 E FOOTHILL BLVD STE 300
PASADENA CA
91107-7102
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax: 626-993-3084
Mailing address:
  • Phone: 626-993-3000
  • Fax: 626-993-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER SCOTT HOWARD
Title or Position: IT DIRECTOR
Credential:
Phone: 626-993-3033