Provider Demographics
NPI:1912182759
Name:MISSION COUNCIL
Entity Type:Organization
Organization Name:MISSION COUNCIL
Other - Org Name:FAMILY DAY TREATMENT AND AFTERCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MPH
Authorized Official - Phone:415-826-6767
Mailing Address - Street 1:474 VALENCIA ST STE 135
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3415
Mailing Address - Country:US
Mailing Address - Phone:415-864-0554
Mailing Address - Fax:415-701-1868
Practice Address - Street 1:474 VALENCIA ST STE 135
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3415
Practice Address - Country:US
Practice Address - Phone:415-864-0554
Practice Address - Fax:415-701-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380008BN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4158640554OtherFACILITY