Basic Information
Provider Information
NPI: 1114159605
EntityType: 2
ReplacementNPI:  
OrganizationName: SOUTH COAST CHILDREN'S SOCIETY, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: SOUTH COAST COMMUNITY SERVICES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25910 ACERO STE 160
Address2:  
City: MISSION VIEJO
State: CA
PostalCode: 926912777
CountryCode: US
TelephoneNumber: 9099806700
FaxNumber:  
Practice Location
Address1: 1323 W COLTON AVE
Address2:  
City: REDLANDS
State: CA
PostalCode: 923744554
CountryCode: US
TelephoneNumber: 9097920747
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2009
LastUpdateDate: 08/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DARLING
AuthorizedOfficialFirstName: KATHLEEN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: COO
AuthorizedOfficialTelephone: 9098384274
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


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