Healthcare Provider Details

I. General information

NPI: 1588860977
Provider Name (Legal Business Name): CONARD HOUSE JACKSON STREET RESIDENTIAL PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 JACKSON ST
SAN FRANCISCO CA
94115-1324
US

IV. Provider business mailing address

2441 JACKSON ST
SAN FRANCISCO CA
94115-1324
US

V. Phone/Fax

Practice location:
  • Phone: 415-346-6380
  • Fax: 415-346-1058
Mailing address:
  • Phone: 415-346-6380
  • Fax: 415-346-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LOUISE FOO
Title or Position: DIRECTOR OF CLINICAL PROGRAMS
Credential: PH.D.
Phone: 415-346-6380