Healthcare Provider Details

I. General information

NPI: 1982124483
Provider Name (Legal Business Name): SAN DIEGO CENTER FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 ARMSTRONG ST
SAN DIEGO CA
92111
US

IV. Provider business mailing address

3002 ARMSTRONG ST
SAN DIEGO CA
92111-5702
US

V. Phone/Fax

Practice location:
  • Phone: 858-277-9550
  • Fax: 858-279-2763
Mailing address:
  • Phone: 858-277-9550
  • Fax: 858-279-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number374602245
License Number StateCA

VIII. Authorized Official

Name: MRS. MISTY HOWARD
Title or Position: DIRECTOR OF QUALITY ASSURANCE
Credential:
Phone: 858-569-2199