Provider Demographics
NPI:1972656056
Name:SOUTH BAY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:SOUTH BAY COMMUNITY SERVICES
Other - Org Name:CAT - EPSDT
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMBO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:619-420-3620
Mailing Address - Street 1:430 F ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3711
Mailing Address - Country:US
Mailing Address - Phone:619-420-3620
Mailing Address - Fax:619-420-8722
Practice Address - Street 1:430 F ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3711
Practice Address - Country:US
Practice Address - Phone:619-420-3620
Practice Address - Fax:619-420-8722
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH BAY COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37GAOtherDMH