Provider Demographics
NPI:1063972263
Name:PENINSULA CENTER FOR CHILDREN AND FAMILIES
Entity type:Organization
Organization Name:PENINSULA CENTER FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-936-1324
Mailing Address - Street 1:655 DEEP VALLEY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3661
Mailing Address - Country:US
Mailing Address - Phone:310-936-1324
Mailing Address - Fax:
Practice Address - Street 1:655 DEEP VALLEY DR STE 220
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3661
Practice Address - Country:US
Practice Address - Phone:310-936-1324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN CALIFORNIA CENTER FOR COUPLES AND FAMILIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty