Provider Demographics
NPI:1184822728
Name:SAN LUIS OBISPO CHILD DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:SAN LUIS OBISPO CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GENDRON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:805-544-0801
Mailing Address - Street 1:1720 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4691
Mailing Address - Country:US
Mailing Address - Phone:805-544-0801
Mailing Address - Fax:805-544-2611
Practice Address - Street 1:1720 BISHOP ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4691
Practice Address - Country:US
Practice Address - Phone:805-544-0801
Practice Address - Fax:805-544-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management