Basic Information
| Provider Information | |||||||||
| NPI: | 1386883817 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VILLAGE FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16718 NICKLAUS DR UNIT 60 | ||||||||
| Address2: | |||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913421675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132483516 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6736 LAUREL CANYON BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916061576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187558786 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2009 | ||||||||
| LastUpdateDate: | 02/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | GUSTAVE-MORGAN | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | ANNETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | CASE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2132483516 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.