Healthcare Provider Details

I. General information

NPI: 1861226698
Provider Name (Legal Business Name): SAVANNAH HULL ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41945 BIG BEAR BLVD
BIG BEAR LAKE CA
92315-2030
US

IV. Provider business mailing address

PO BOX 2342
BIG BEAR CITY CA
92314-2342
US

V. Phone/Fax

Practice location:
  • Phone: 909-866-5070
  • Fax:
Mailing address:
  • Phone: 909-436-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: