Provider Demographics
NPI:1679886642
Name:MORRISANIA WEST INC
Entity Type:Organization
Organization Name:MORRISANIA WEST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:415-552-4660
Mailing Address - Street 1:205 13TH ST # 3300
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2461
Mailing Address - Country:US
Mailing Address - Phone:415-552-4660
Mailing Address - Fax:415-552-4137
Practice Address - Street 1:205 13TH ST # 3300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2461
Practice Address - Country:US
Practice Address - Phone:415-552-4660
Practice Address - Fax:415-552-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health