Healthcare Provider Details

I. General information

NPI: 1235984030
Provider Name (Legal Business Name): NORTH BEACH CITIZENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 KEARNY ST
SAN FRANCISCO CA
94133-4525
US

IV. Provider business mailing address

1034 KEARNY ST
SAN FRANCISCO CA
94133-4525
US

V. Phone/Fax

Practice location:
  • Phone: 415-772-0918
  • Fax: 415-772-8273
Mailing address:
  • Phone: 415-772-0918
  • Fax: 415-772-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTIE FAIRCHILD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 415-772-0918