Healthcare Provider Details

I. General information

NPI: 1659628220
Provider Name (Legal Business Name): IRIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 GOUGH ST
SAN FRANCISCO CA
94103-1290
US

IV. Provider business mailing address

12 GOUGH ST
SAN FRANCISCO CA
94103
US

V. Phone/Fax

Practice location:
  • Phone: 415-864-0116
  • Fax:
Mailing address:
  • Phone: 415-864-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: PAMELA V GRIMM
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 415-864-2364