Provider Demographics
NPI:1245605559
Name:YMCA OF SAN DIEGO COUNTY
Entity Type:Organization
Organization Name:YMCA OF SAN DIEGO COUNTY
Other - Org Name:YOUTH & FAMILY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMMLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-281-8313
Mailing Address - Street 1:2929 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4251
Mailing Address - Country:US
Mailing Address - Phone:619-281-8313
Mailing Address - Fax:
Practice Address - Street 1:3304 IDLEWILD WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3508
Practice Address - Country:US
Practice Address - Phone:858-270-8213
Practice Address - Fax:858-270-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370808617322D00000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA370808617OtherCOMMUNITY CARE LICENSE FACILITY #