Provider Demographics
NPI:1558834374
Name:BH-SDOPCO, LLC
Entity Type:Organization
Organization Name:BH-SDOPCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:CECELIA
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-667-6133
Mailing Address - Street 1:7050 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1535
Mailing Address - Country:US
Mailing Address - Phone:619-667-6133
Mailing Address - Fax:619-667-6054
Practice Address - Street 1:1250 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4300
Practice Address - Country:US
Practice Address - Phone:619-487-9201
Practice Address - Fax:619-487-9212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BH-SDOPCO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital