Provider Demographics
NPI:1467595140
Name:PROVIDENCE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:PROVIDENCE COMMUNITY SERVICES
Other - Org Name:THE CATALYST PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:ST.CYR
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:858-300-0460
Mailing Address - Street 1:3240 OLIVE ST APT 50
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1721
Mailing Address - Country:US
Mailing Address - Phone:619-248-3835
Mailing Address - Fax:
Practice Address - Street 1:3240 OLIVE ST APT 50
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1721
Practice Address - Country:US
Practice Address - Phone:619-248-3835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management