Provider Demographics
NPI:1972898088
Name:SAN DIEGO CENTER FOR CHILDREN
Entity Type:Organization
Organization Name:SAN DIEGO CENTER FOR CHILDREN
Other - Org Name:FFA STABILIZATION AND TREATMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-569-2199
Mailing Address - Street 1:2655 CAMINO DEL RIO N STE 450
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1603
Mailing Address - Country:US
Mailing Address - Phone:858-633-4102
Mailing Address - Fax:858-737-6972
Practice Address - Street 1:2655 CAMINO DEL RIO N STE 450
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1603
Practice Address - Country:US
Practice Address - Phone:858-633-4102
Practice Address - Fax:858-737-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37OAOtherMEDI-CAL