Provider Demographics
NPI:1013261635
Name:POTRERO HILL HEALTH CENTER
Entity Type:Organization
Organization Name:POTRERO HILL HEALTH CENTER
Other - Org Name:DEPARTMENT OF PUBLIC HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:BEHAVIORIST ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:EULA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-920-1263
Mailing Address - Street 1:13475 BANCROFT AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2563
Mailing Address - Country:US
Mailing Address - Phone:415-240-1683
Mailing Address - Fax:415-550-1639
Practice Address - Street 1:1050 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-3328
Practice Address - Country:US
Practice Address - Phone:415-920-1263
Practice Address - Fax:415-550-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare