=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083820385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOJOURN SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 08/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1619 S BROADWAY
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-7601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-614-9535
-----------------------------------------------------
Fax | 805-614-9390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1619 S BROADWAY
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-7601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-614-9395
-----------------------------------------------------
Fax | 805-614-9390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. REBECCA ROBERTSON
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 805-614-9535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------