Healthcare Provider Details

I. General information

NPI: 1235712837
Provider Name (Legal Business Name): YOUTH SERVICE BUREAU OF THE YMCA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1486 HUNTINGTON AVE STE 100
SOUTH SAN FRANCISCO CA
94080-5971
US

IV. Provider business mailing address

1486 HUNTINGTON AVE STE 100
SOUTH SAN FRANCISCO CA
94080-5971
US

V. Phone/Fax

Practice location:
  • Phone: 650-877-8642
  • Fax:
Mailing address:
  • Phone: 650-877-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA HOEPKE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 650-877-8642