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General NPI Number Information
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NPI Number | 1114049186
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Entity Type | Organization
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Legal Business Name | HOUSE OF METAMORPHOSIS, INC.
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2970 MARKET ST
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City | SAN DIEGO
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State | CA
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Zip | 92102-3241
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Country | US
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Telephone | 619-236-9217
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Fax | 619-232-0855
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Provider Business Mailing Address
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Address Line | 2970 MARKET ST
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City | SAN DIEGO
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State | CA
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Zip | 92102-3241
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Country | US
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Telephone | 619-236-9217
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Fax | 619-232-0855
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. BEVERLY MONROE
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Credential |
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Telephone | 619-236-9217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 370021AN
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License Number State | CA
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