Healthcare Provider Details

I. General information

NPI: 1619393675
Provider Name (Legal Business Name): CONARD HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 MISSION ST SUITE 200
SAN FRANCISCO CA
94103-2623
US

IV. Provider business mailing address

1385 MISSION ST SUITE 200
SAN FRANCISCO CA
94103-2623
US

V. Phone/Fax

Practice location:
  • Phone: 415-864-4002
  • Fax: 415-864-7093
Mailing address:
  • Phone: 415-864-4002
  • Fax: 415-864-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number89492
License Number StateCA

VIII. Authorized Official

Name: ROGER MENDOZA
Title or Position: AD-OPERATIONS
Credential:
Phone: 415-864-4002