Healthcare Provider Details

I. General information

NPI: 1205187135
Provider Name (Legal Business Name): WESTSIDE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 OAK ST
SAN FRANCISCO CA
94117-2216
US

IV. Provider business mailing address

1153 OAK ST
SAN FRANCISCO CA
94117-2216
US

V. Phone/Fax

Practice location:
  • Phone: 415-431-9000
  • Fax:
Mailing address:
  • Phone: 415-431-9000
  • Fax:

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: DAVID POWELL
Title or Position: CHIEF PROGRAM OFFICER
Credential:
Phone: 415-431-9000