Provider Demographics
NPI:1134461031
Name:COUNTY OF SAN LUIS OBISPO
Entity Type:Organization
Organization Name:COUNTY OF SAN LUIS OBISPO
Other - Org Name:SAN LUIS OBISPO COUNTY DRUG AND ALCOHOL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:805-781-4753
Mailing Address - Street 1:2180 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4513
Mailing Address - Country:US
Mailing Address - Phone:805-781-4753
Mailing Address - Fax:805-781-1227
Practice Address - Street 1:2820 SANTA ROSA CREEK RD RM 4
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-3524
Practice Address - Country:US
Practice Address - Phone:805-781-4753
Practice Address - Fax:805-781-1227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center