Provider Demographics
NPI:1740665108
Name:SAN DIEGO BRAIN INJURY FOUNDATION
Entity type:Organization
Organization Name:SAN DIEGO BRAIN INJURY FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-294-6541
Mailing Address - Street 1:PO BOX 84601
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92138-4601
Mailing Address - Country:US
Mailing Address - Phone:619-294-6541
Mailing Address - Fax:619-294-2911
Practice Address - Street 1:2033 ORO VERDE RD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-4810
Practice Address - Country:US
Practice Address - Phone:760-480-7468
Practice Address - Fax:760-741-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372002856310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility