Provider Demographics
NPI:1922442060
Name:MISSION FAMILY CENTER
Entity Type:Organization
Organization Name:MISSION FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULY
Authorized Official - Middle Name:
Authorized Official - Last Name:UGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-642-4571
Mailing Address - Street 1:759 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1908
Mailing Address - Country:US
Mailing Address - Phone:415-642-4550
Mailing Address - Fax:415-695-6963
Practice Address - Street 1:759 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1908
Practice Address - Country:US
Practice Address - Phone:415-642-4550
Practice Address - Fax:415-695-6963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA174400000XOtherSERVICE PROVIDER SPECIALIST