Provider Demographics
NPI:1689708349
Name:SAN DIEGO SPAN
Entity Type:Organization
Organization Name:SAN DIEGO SPAN
Other - Org Name:LIFESPAN PUENTE DE VIDA PRIENTA DE VIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:858-452-3915
Mailing Address - Street 1:PO BOX 86020
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92138-6020
Mailing Address - Country:US
Mailing Address - Phone:858-452-3915
Mailing Address - Fax:858-452-1798
Practice Address - Street 1:3013 WOODFORD DR
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-3549
Practice Address - Country:US
Practice Address - Phone:858-452-3915
Practice Address - Fax:858-452-1798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility