Healthcare Provider Details

I. General information

NPI: 1710439559
Provider Name (Legal Business Name): FRED FINCH YOUTH CENTER CARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 COMPLEX DR STE 300
SAN DIEGO CA
92123-1453
US

IV. Provider business mailing address

8787 COMPLEX DR STE 300
SAN DIEGO CA
92123-1453
US

V. Phone/Fax

Practice location:
  • Phone: 619-797-1090
  • Fax: 858-444-8827
Mailing address:
  • Phone: 619-797-1090
  • Fax: 858-444-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN L MURPHY
Title or Position: BUSINESS DEVELOPMENT ANALYST
Credential:
Phone: 858-354-1389