Provider Demographics
NPI:1134650070
Name:NALLS FOUNDATION
Entity Type:Organization
Organization Name:NALLS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-505-6427
Mailing Address - Street 1:PO BOX 460338
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94146-0338
Mailing Address - Country:US
Mailing Address - Phone:415-586-1275
Mailing Address - Fax:
Practice Address - Street 1:131 PERSIA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2717
Practice Address - Country:US
Practice Address - Phone:415-586-1275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385650019322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children