Provider Demographics
NPI:1336209220
Name:COUNTY OF SAN DIEGO
Entity Type:Organization
Organization Name:COUNTY OF SAN DIEGO
Other - Org Name:BHS-NORTH CENTRAL BEHAVIORAL HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR,BEHAVIORAL HEALTH SERVICEC
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-563-2700
Mailing Address - Street 1:1250 MORENA BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3815
Mailing Address - Country:US
Mailing Address - Phone:619-692-8750
Mailing Address - Fax:619-692-8779
Practice Address - Street 1:1250 MORENA BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3815
Practice Address - Country:US
Practice Address - Phone:619-692-8750
Practice Address - Fax:619-692-8779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3703Medicaid
CA3791Medicaid