Provider Demographics
NPI:1851533798
Name:COUNTY OF SAN LUIS OBISPO
Entity Type:Organization
Organization Name:COUNTY OF SAN LUIS OBISPO
Other - Org Name:SAN LUIS OBISPO CO MENTAL HEALTH SVCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FISCAL OFFICER BEHAVIORAL HEA
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-788-2932
Mailing Address - Street 1:1103 TORO ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3329
Mailing Address - Country:US
Mailing Address - Phone:805-781-4700
Mailing Address - Fax:805-781-1273
Practice Address - Street 1:1103 TORO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3329
Practice Address - Country:US
Practice Address - Phone:805-781-4700
Practice Address - Fax:805-781-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP065AMedicare PIN