Provider Demographics
NPI:1740348242
Name:COUNTY OF SAN DIEGO
Entity type:Organization
Organization Name:COUNTY OF SAN DIEGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BEHAVIORAL HEALTH SERVICE
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 1:1000 BROADWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-4899
Mailing Address - Country:US
Mailing Address - Phone:619-401-5500
Mailing Address - Fax:619-401-5454
Practice Address - Street 1:1000 BROADWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4899
Practice Address - Country:US
Practice Address - Phone:619-401-5500
Practice Address - Fax:619-401-5454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SAN DIEGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3703Medicaid
CA3701Medicaid