Provider Demographics
NPI: | 1912249723 |
---|---|
Name: | COUNTY OF SAN LUIS OBISPO |
Entity Type: | Organization |
Organization Name: | COUNTY OF SAN LUIS OBISPO |
Other - Org Name: | SAN LUIS OBISPO COUNTY DRUG AND ALCOHOL SERVICES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIVISION MANAGER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | STARLENE |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | GRABER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD, LMFT |
Authorized Official - Phone: | 805-781-4753 |
Mailing Address - Street 1: | 2180 JOHNSON AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN LUIS OBISPO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93401-4513 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 805-781-4753 |
Mailing Address - Fax: | 805-781-1227 |
Practice Address - Street 1: | 495 VALLEY RD |
Practice Address - Street 2: | |
Practice Address - City: | ARROYO GRANDE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93420-3928 |
Practice Address - Country: | US |
Practice Address - Phone: | 805-781-4753 |
Practice Address - Fax: | 805-781-1227 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-03-19 |
Last Update Date: | 2014-03-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |