Healthcare Provider Details

I. General information

NPI: 1750596300
Provider Name (Legal Business Name): CENTER ON JUVENILE AND CRIMINAL JUSTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BOARDMAN PL
SAN FRANCISCO CA
94103-4729
US

IV. Provider business mailing address

40 BOARDMAN PL
SAN FRANCISCO CA
94103-4729
US

V. Phone/Fax

Practice location:
  • Phone: 415-621-5661
  • Fax: 415-621-5466
Mailing address:
  • Phone: 415-621-5661
  • Fax: 415-621-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. DANIEL MACALLAIR
Title or Position: EXECUTIVE DIRECTOR
Credential: MPA
Phone: 415-621-5661