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SAN FERNANDO MISSION GROUP HOME NPI 1295282739


NPI Information

NPI: 1295282739
Provider Name: SAN FERNANDO MISSION GROUP HOME
Classification: Residential Treatment Facility, Emotionally Disturbed Children - 322D00000X
Entity Type: Organization

CLIA Number: 05D1072343

Address:
17157 SAN FERNANDO MISSION BLVD.
GRANADA HILLS, CA
ZIP 91344
Phone: (818) 488-9046
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SAN FERNANDO MISSION GROUP HOME is a residential treatment facility emotionally disturbed children in Granada Hills, CA. The provider is a residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently. SAN FERNANDO MISSION GROUP HOME NPI is 1295282739. The provider is registered as an organization entity type.

The provider's business location address is:

17157 SAN FERNANDO MISSION BLVD.
GRANADA HILLS, CA
ZIP 91344
Phone: (818) 488-9046
Fax: (818) 488-9046

The provider's authorized official is Jorge C Marquez .
The authorized official title is Executive Director and has the following contact phone number (818) 592-2960.

The CLIA number assigned to this NPI record is 05D1072343 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/1/2016 and was last updated on 9/1/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1322D00000XResidential Treatment Facility, Emotionally Disturbed Children198208017CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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