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General NPI Number Information
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NPI Number | 1730410853
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Entity Type | Organization
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Legal Business Name | SAN DIEGO YOUTH SERVICES
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 968 CORTE MARIA AVE
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City | CHULA VISTA
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State | CA
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Zip | 91911-2219
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Country | US
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Telephone | 510-565-6742
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Fax |
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Provider Business Mailing Address
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Address Line | 3255 WING ST
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City | SAN DIEGO
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State | CA
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Zip | 92110-4638
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Country | US
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Telephone | 619-221-8600
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Fax |
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Authorized Official
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Title or Position | CHILD CARE WORKER / REHABILITATION
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Name | JAMES G CASSON
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Credential |
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Telephone | 858-366-3199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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