Provider Demographics
NPI:1346547924
Name:HHSA-PA/PG
Entity Type:Organization
Organization Name:HHSA-PA/PG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-694-3500
Mailing Address - Street 1:5201 RUFFIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1699
Mailing Address - Country:US
Mailing Address - Phone:858-694-3500
Mailing Address - Fax:
Practice Address - Street 1:5201 RUFFIN RD STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1699
Practice Address - Country:US
Practice Address - Phone:858-694-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management