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General NPI Number Information
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NPI Number | 1194854182
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Entity Type | Organization
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Legal Business Name | FRED FINCH YOUTH CENTERS
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10025 LOS RANCHITOS RD
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City | LAKESIDE
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State | CA
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Zip | 92040-2723
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Country | US
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Telephone | 619-258-4012
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Fax |
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Provider Business Mailing Address
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Address Line | 453 13TH ST APT 337
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City | SAN DIEGO
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State | CA
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Zip | 92101-7562
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Country | US
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Telephone | 323-687-7492
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. BRUCE WEXLER
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Credential | MFT
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Telephone | 619-258-4012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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