Healthcare Provider Details

I. General information

NPI: 1609053180
Provider Name (Legal Business Name): COMMUNITY YOUTH CENTER OF SAN FRANCISCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2008
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 POST ST
SAN FRANCISCO CA
94109-5603
US

IV. Provider business mailing address

1038 POST ST
SAN FRANCISCO CA
94109-5603
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-2636
  • Fax: 415-775-1345
Mailing address:
  • Phone: 415-775-2636
  • Fax: 415-775-1345

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: MS. SARAH CHING TING WAN
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.W.
Phone: 415-775-2636