Provider Demographics
NPI:1376722405
Name:DEPT. OF PUBLIE HEALTH-MCAH
Entity Type:Organization
Organization Name:DEPT. OF PUBLIE HEALTH-MCAH
Other - Org Name:MATERNAL CHILD ADOLESCENT HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANNIE
Authorized Official - Middle Name:ADELMAN
Authorized Official - Last Name:HEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:415-657-1747
Mailing Address - Street 1:1301 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4005
Mailing Address - Country:US
Mailing Address - Phone:415-292-1344
Mailing Address - Fax:
Practice Address - Street 1:1301 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4005
Practice Address - Country:US
Practice Address - Phone:415-292-1344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA219747261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health