Provider Demographics
NPI:1538322458
Name:SF RECONNECT
Entity Type:Organization
Organization Name:SF RECONNECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:YOUTH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TABANGCURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-776-1001
Mailing Address - Street 1:2201 SUTTER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2201 SUTTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3109
Practice Address - Country:US
Practice Address - Phone:415-776-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health