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General NPI Number Information
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NPI Number | 1316787377
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Entity Type | Organization
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Legal Business Name | FIGHTING BACK SANTA MARIA VALLEY
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 201 S MILLER ST STE 209
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City | SANTA MARIA
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State | CA
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Zip | 93454-5249
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Country | US
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Telephone | 805-720-6220
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Fax | 805-621-5859
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Provider Business Mailing Address
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Address Line | PO BOX 184
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City | SANTA MARIA
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State | CA
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Zip | 93456-0184
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Country | US
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Telephone | 805-346-1774
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Fax | 805-621-5859
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | FRANK EDWIN WEAVER
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Credential | MSW, MDR
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Telephone | 805-346-1774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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