Provider Demographics
NPI:1497978910
Name:COMMUNITY RESEARCH FOUNDATION INC
Entity Type:Organization
Organization Name:COMMUNITY RESEARCH FOUNDATION INC
Other - Org Name:MOBILE ADOLESCENT SERVICES TEAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-275-0822
Mailing Address - Street 1:1202 MORENA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3841
Mailing Address - Country:US
Mailing Address - Phone:619-398-3261
Mailing Address - Fax:619-275-2023
Practice Address - Street 1:1260 MORENA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3850
Practice Address - Country:US
Practice Address - Phone:619-398-3261
Practice Address - Fax:619-275-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37HH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37HHMedicaid