Provider Demographics
NPI:1871640938
Name:IRIS CENTER
Entity Type:Organization
Organization Name:IRIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PMAELA
Authorized Official - Middle Name:VERNELL
Authorized Official - Last Name:FAIRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-864-2364
Mailing Address - Street 1:333 VALENCIA ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3547
Mailing Address - Country:US
Mailing Address - Phone:415-864-2364
Mailing Address - Fax:415-864-0116
Practice Address - Street 1:333 VALENCIA ST
Practice Address - Street 2:SUITE 222
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3547
Practice Address - Country:US
Practice Address - Phone:415-864-2364
Practice Address - Fax:415-864-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty