Healthcare Provider Details

I. General information

NPI: 1114248275
Provider Name (Legal Business Name): COMMUNITY RESEARCH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 BROADWAY
EL CAJON CA
92021-5201
US

IV. Provider business mailing address

1664 BROADWAY
EL CAJON CA
92021-5201
US

V. Phone/Fax

Practice location:
  • Phone: 619-579-8685
  • Fax: 619-579-1969
Mailing address:
  • Phone: 619-579-8685
  • Fax: 619-579-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JACKIE EVANS
Title or Position: ADMINISTRATIVE PROGRAM AID
Credential:
Phone: 619-579-8685