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General NPI Number Information
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NPI Number | 1902920176
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Entity Type | Organization
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Legal Business Name | HILLSIDES
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 149 PASADENA AVE STE A
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3351
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Country | US
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Telephone | 323-254-2274
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Fax |
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Provider Business Mailing Address
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Address Line | 149 PASADENA AVE STE A
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3351
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Country | US
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Telephone | 323-274-3065
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | STACEY ROTH
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Credential | LCSW
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Telephone | 323-543-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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