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General NPI Number Information
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NPI Number | 1225474703
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Entity Type | Organization
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Legal Business Name | COMMUNITY INTEGRATION SERVICES INC.
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Dates
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Enumeration Date | 05/10/2013
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Last Update Date | 05/10/2013
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Provider Practice Location Address
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Address Line | 10100 BALBOA BLVD
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City | GRANADA HILLS
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State | CA
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Zip | 91344-7401
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Country | US
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Telephone | 818-772-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 10100 BALBOA BLVD
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City | GRANADA HILLS
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State | CA
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Zip | 91344-7401
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Country | US
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Telephone | 818-772-1155
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | ROBERT D. ERIO
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Credential |
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Telephone | 818-772-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 197606348
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License Number State | CA
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