Provider Demographics
NPI:1508588476
Name:UPAC TEEN RECOVERY CENTER
Entity Type:Organization
Organization Name:UPAC TEEN RECOVERY CENTER
Other - Org Name:KING-CHAVEZ COMMUNITY HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELCAMP PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-232-6454
Mailing Address - Street 1:3288 EL CAJON BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1430
Mailing Address - Country:US
Mailing Address - Phone:619-521-5720
Mailing Address - Fax:
Practice Address - Street 1:201 A ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4003
Practice Address - Country:US
Practice Address - Phone:619-704-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION OF PAN ASIAN COMMUNITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health