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General NPI Number Information
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NPI Number | 1376347963
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Entity Type | Organization
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Legal Business Name | AMITY SAN DIEGO LLC
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 3565 DEL REY ST STE 202
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City | SAN DIEGO
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State | CA
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Zip | 92109-5703
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Country | US
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Telephone | 888-666-4405
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Fax | 657-441-0142
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Provider Business Mailing Address
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Address Line | 1800 OKEECHOBEE RD STE 200
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-5207
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Country | US
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Telephone | 657-441-0141
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PATRICK ROBERT SANTOSUOSSO
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Credential |
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Telephone | 561-526-6697
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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 |
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License Number State |
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