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General NPI Number Information
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NPI Number | 1245400670
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Entity Type | Organization
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Legal Business Name | GREAT EXPECTATIONS SERVICES INC
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 822 GRANADA DR
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City | VISTA
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State | CA
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Zip | 92083-4733
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Country | US
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Telephone | 714-812-8684
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Fax | 949-218-1670
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Provider Business Mailing Address
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Address Line | 555 N EL CAMINO REAL SUITE A432
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-6740
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Country | US
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Telephone | 714-812-8684
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Fax | 949-218-1670
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. AZIN BAIRD
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Credential | B.S.
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Telephone | 714-812-8684
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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 | CA
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