Healthcare Provider Details

I. General information

NPI: 1609184035
Provider Name (Legal Business Name): PROJECT ENABLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 EUCLID AVE STE 102
SAN DIEGO CA
92114-3611
US

IV. Provider business mailing address

286 EUCLID AVE STE 102
SAN DIEGO CA
92114-3611
US

V. Phone/Fax

Practice location:
  • Phone: 619-266-2111
  • Fax: 619-266-0496
Mailing address:
  • Phone: 619-266-2111
  • Fax: 619-266-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: EVELINA JAIME
Title or Position: DIRECTOR
Credential: LCSW
Phone: 619-266-2111