Provider Demographics
NPI:1568528040
Name:WESTSIDE COMMUNITY MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:WESTSIDE COMMUNITY MENTAL HEALTH, INC.
Other - Org Name:WESTSIDE CALWORKS
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:415-431-9000
Mailing Address - Street 1:1153 OAK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2216
Mailing Address - Country:US
Mailing Address - Phone:415-431-9000
Mailing Address - Fax:415-431-1813
Practice Address - Street 1:1663 MISSION ST STE 310
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2486
Practice Address - Country:US
Practice Address - Phone:415-581-0449
Practice Address - Fax:415-581-0458
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSIDE COMMUNITY MENTAL HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-28
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38AVMedicaid