Healthcare Provider Details

I. General information

NPI: 1417898503
Provider Name (Legal Business Name): GREATER SAN FRANCISCO TEEN CHALLENGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 VALENCIA ST
SAN FRANCISCO CA
94110-3717
US

IV. Provider business mailing address

1464 VALENCIA ST
SAN FRANCISCO CA
94110-3717
US

V. Phone/Fax

Practice location:
  • Phone: 415-285-1353
  • Fax:
Mailing address:
  • Phone: 415-285-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TYLER JAMES MOORE POOLE
Title or Position: EXTENDED PROGRAM COORDINATOR
Credential: SUDRC1
Phone: 415-678-0627