Provider Demographics
NPI:1194048785
Name:WALDEN ENVIRONMENT
Entity type:Organization
Organization Name:WALDEN ENVIRONMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY ASSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-801-7140
Mailing Address - Street 1:8525 GIBBS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1758
Mailing Address - Country:US
Mailing Address - Phone:619-584-5777
Mailing Address - Fax:619-584-5757
Practice Address - Street 1:6345 BALBOA BLVD STE 130
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1510
Practice Address - Country:US
Practice Address - Phone:818-365-3665
Practice Address - Fax:818-349-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency