Provider Demographics
NPI:1467675918
Name:SANTA BARBARA CENTER FOR CHANGE
Entity Type:Organization
Organization Name:SANTA BARBARA CENTER FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:CATS
Authorized Official - Phone:805-898-1018
Mailing Address - Street 1:2950 STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3464
Mailing Address - Country:US
Mailing Address - Phone:805-898-1018
Mailing Address - Fax:805-898-1056
Practice Address - Street 1:2950 STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3464
Practice Address - Country:US
Practice Address - Phone:805-898-1018
Practice Address - Fax:805-898-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420031AN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42ABMedicaid