Provider Demographics
NPI:1710875455
Name:UPAC TEEN RECOVERY CENTER
Entity type:Organization
Organization Name:UPAC TEEN RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-521-5720
Mailing Address - Street 1:3288 EL CAJON BLVD. SUITE 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104
Mailing Address - Country:US
Mailing Address - Phone:619-521-5720
Mailing Address - Fax:619-521-5728
Practice Address - Street 1:4777 IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113
Practice Address - Country:US
Practice Address - Phone:619-521-5720
Practice Address - Fax:619-521-5728
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPAC TRC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health