Healthcare Provider Details

I. General information

NPI: 1295514149
Provider Name (Legal Business Name): FIELDS COMP. YOUTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 PORTOLA ST
SAN BERNARDINO CA
92407-6930
US

IV. Provider business mailing address

8780 19TH ST # 196
ALTA LOMA CA
91701-4608
US

V. Phone/Fax

Practice location:
  • Phone: 909-376-4148
  • Fax:
Mailing address:
  • Phone: 909-322-6980
  • Fax: 909-466-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ARBY ENRICO FIELDS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 909-322-6980