MEDICARE: CITY CHURCH SAN FRANCISCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1063954741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY CHURCH SAN FRANCISCO

Provider Business Mailing Address
First Line	:	1388 SUTTER ST
Second Line	:	SUITE 412
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-5427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1388 SUTTER ST
Second Line	:	SUITE 412
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-5427
Country	:	US
Telephone Number	:	415-346-6994
Fax Number	:

Authorized Official
Title or Position	:	COUNSELING CENTER DIRECTOR
Name	:	JOHNNY LALONDE
Credential	:
Telephone Number	:	415-346-6994

Provider Enumeration Date	:	11/10/2016
Last Update Date	:	11/10/2016

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Directions to “CITY CHURCH SAN FRANCISCO ” Practice Location

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