Basic Information
| Provider Information | |||||||||
| NPI: | 1053546887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S INSTITUTE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 W TEMPLE ST BLDG ABC | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900264915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133855100 | ||||||||
| FaxNumber: | 2132607791 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 HUGHES WAY STE C100 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908101808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133855100 | ||||||||
| FaxNumber: | 2133831820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2009 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | SINGER | ||||||||
| AuthorizedOfficialFirstName: | MARTINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2133855100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7779A | 01 | CA | LOS ANGELES COUNTY DEPARTMENT OF MENTAL HEALTH | OTHER |