Provider Demographics
NPI:1447512108
Name:COMMUNITY SERVICE PROGRAMS
Entity type:Organization
Organization Name:COMMUNITY SERVICE PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NIDIA
Authorized Official - Middle Name:MARISA
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-576-1531
Mailing Address - Street 1:980 CATALINA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2748
Mailing Address - Country:US
Mailing Address - Phone:949-494-4311
Mailing Address - Fax:
Practice Address - Street 1:980 CATALINA
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2748
Practice Address - Country:US
Practice Address - Phone:949-494-4311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness