MEDICARE: MENTAL HEALTH CENTER OF SAN DIEGO

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	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1134827033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH CENTER OF SAN DIEGO

Provider Business Mailing Address
First Line	:	960 GRAND AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13795 ROYAL MELBOURNE SQ
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3642
Country	:	US
Telephone Number	:	619-450-1874
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NICHOLAS BEETS
Credential	:
Telephone Number	:	949-933-1931

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	02/20/2023

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