Healthcare Provider Details

I. General information

NPI: 1265916696
Provider Name (Legal Business Name): CITY & COUNTY OF SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 POLK ST
SAN FRANCISCO CA
94102-3333
US

IV. Provider business mailing address

555 POLK ST
SAN FRANCISCO CA
94102-3333
US

V. Phone/Fax

Practice location:
  • Phone: 415-202-2810
  • Fax:
Mailing address:
  • Phone: 415-202-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHONA G. BAUTISTA-PERALTA
Title or Position: COMPLIANCE OFFICER
Credential: LCSW
Phone: 415-255-3706