Provider Demographics
NPI:1669690921
Name:NEIGHBORHOOD HOUSE ASSOCIATION
Entity type:Organization
Organization Name:NEIGHBORHOOD HOUSE ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:858-715-2642
Mailing Address - Street 1:851 S 35TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-2701
Mailing Address - Country:US
Mailing Address - Phone:619-233-6691
Mailing Address - Fax:619-233-6693
Practice Address - Street 1:851 S 35TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-2701
Practice Address - Country:US
Practice Address - Phone:619-233-6691
Practice Address - Fax:619-233-6693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70072FMedicaid