Healthcare Provider Details

I. General information

NPI: 1750042347
Provider Name (Legal Business Name): MENTAL HEALTH CENTER OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 BEN ST
SAN DIEGO CA
92111-3524
US

IV. Provider business mailing address

960 GRAND AVE
SAN DIEGO CA
92109-4064
US

V. Phone/Fax

Practice location:
  • Phone: 619-450-1874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS BEETS
Title or Position: DIRECTOR
Credential:
Phone: 949-933-1931