Healthcare Provider Details

I. General information

NPI: 1336201490
Provider Name (Legal Business Name): NEW HAVEN YOUTH & FAMILY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W LOS ANGELES DR
VISTA CA
92083-3101
US

IV. Provider business mailing address

PO BOX 1199
VISTA CA
92085-1199
US

V. Phone/Fax

Practice location:
  • Phone: 760-630-4035
  • Fax: 760-630-4030
Mailing address:
  • Phone: 760-630-4035
  • Fax: 760-630-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number33EJO1
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DOREEN QUINN
Title or Position: CEO
Credential:
Phone: 760-630-4035