Provider Demographics
NPI:1639640212
Name:CROWNVIEW CO-OCCURRING INSTITUTE
Entity Type:Organization
Organization Name:CROWNVIEW CO-OCCURRING INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-231-1170
Mailing Address - Street 1:315 N CLEMENTINE ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2806
Mailing Address - Country:US
Mailing Address - Phone:760-231-1170
Mailing Address - Fax:760-231-5303
Practice Address - Street 1:212 N CLEMENTINE ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2805
Practice Address - Country:US
Practice Address - Phone:760-231-1170
Practice Address - Fax:760-231-5303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROWNVIEW CO-OCCURRING INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health