Provider Demographics
NPI:1760477467
Name:JEWISH FAMILY SERVICE OF SAN DIEGO
Entity Type:Organization
Organization Name:JEWISH FAMILY SERVICE OF SAN DIEGO
Other - Org Name:JEWISH FAMILY SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:858-637-3000
Mailing Address - Street 1:8804 BALBOA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1506
Mailing Address - Country:US
Mailing Address - Phone:858-637-3000
Mailing Address - Fax:858-637-3260
Practice Address - Street 1:8804 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1506
Practice Address - Country:US
Practice Address - Phone:858-637-3000
Practice Address - Fax:858-637-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251V00000X
251X00000X, 332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251X00000XAgenciesSupports Brokerage
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSWG00050Medicaid
CAGPS001140Medicaid
CACSWG00051Medicaid
CAGPS001141Medicaid
CACSWG00051Medicaid