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General NPI Number Information
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NPI Number | 1609073691
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Entity Type | Organization
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Legal Business Name | TRANSITIONS-MENTAL HEALTH ASSOCIATION
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 1511 OSOS ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4037
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Country | US
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Telephone | 805-541-0107
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Fax | 805-544-0741
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Provider Business Mailing Address
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Address Line | PO BOX 15408
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93406-5408
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Country | US
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Telephone | 805-541-5144
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Fax | 805-541-9480
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JILL BOLSTER-WHITE
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Credential |
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Telephone | 805-541-5144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 405801098
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License Number State | CA
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