Healthcare Provider Details

I. General information

NPI: 1386556637
Provider Name (Legal Business Name): LOGAN HEIGHTS COMMUNITY DEVELOPMENT CORPORATION (CDC)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 IMPERIAL AVE
SAN DIEGO CA
92102-4128
US

IV. Provider business mailing address

3040 IMPERIAL AVE
SAN DIEGO CA
92102-4128
US

V. Phone/Fax

Practice location:
  • Phone: 619-858-0563
  • Fax: 619-858-0564
Mailing address:
  • Phone: 619-858-0563
  • Fax: 619-858-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MONTE A JONES
Title or Position: PRESIDENT AND CEO
Credential: MBA
Phone: 619-858-0563