Organization
COLLEGE COMMUNITY SERVICES
Active
Other names
AMHS Clarvida Opportunity Knocks FSP
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY GINTER MBA, CBCS (DIRECTOR OF STATE OPERATIONS)
(657) 465-9497
Entity
Organization
Contact information
Practice address
631 S BROOKHURST ST STE 104, ANAHEIM, CA 92804-3510
(714) 620-8131
(714) 620-8132
Mailing address
8337 TELEGRAPH RD STE 300, PICO RIVERA, CA 90660-4957
(562) 467-5440
(562) 467-5553
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30DD
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
02/20/2007
Last updated
08/14/2024
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