Healthcare Provider Details

I. General information

NPI: 1336275056
Provider Name (Legal Business Name): FOOTHILL FAMILY SERVICE - HUDSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S HUDSON AVE
PASADENA CA
91101-2606
US

IV. Provider business mailing address

111 S HUDSON AVE
PASADENA CA
91101-2606
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax: 626-795-7080
Mailing address:
  • Phone: 626-993-3000
  • Fax: 626-313-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHRIS HOWARD
Title or Position: IT DIRECTOR
Credential:
Phone: 626-993-3000