Provider Demographics
NPI:1780006767
Name:SAN DIEGO CENTER FOR CHILDREN
Entity Type:Organization
Organization Name:SAN DIEGO CENTER FOR CHILDREN
Other - Org Name:WRAPWORKS SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-569-2199
Mailing Address - Street 1:3322 SWEETWATER SPRINGS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3142
Mailing Address - Country:US
Mailing Address - Phone:858-277-9550
Mailing Address - Fax:
Practice Address - Street 1:3322 SWEETWATER SPRINGS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-3142
Practice Address - Country:US
Practice Address - Phone:858-277-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health