Provider Demographics
NPI:1689186652
Name:OPERATION SAFEHOUSE
Entity Type:Organization
Organization Name:OPERATION SAFEHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROGRAMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-285-1740
Mailing Address - Street 1:9685 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3660
Mailing Address - Country:US
Mailing Address - Phone:760-285-1740
Mailing Address - Fax:
Practice Address - Street 1:3043 SAFFRON CT
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3778
Practice Address - Country:US
Practice Address - Phone:760-285-1740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA84662OtherMARRIAGE AND FAMILY THERAPIST INTERN
CA98084OtherMARRIAGE AND FAMILY THERAPIST INTERN
CA102741OtherMARRIAGE AND FAMILY THERAPIST INTERN
CA2176OtherPROFESSIONAL CLINICAL COUNSELOR INTERN