MEDICARE: YMCA OF SAN DIEGO COUNTY

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	370808617	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	370808617	OTHER	CA	COMMUNITY CARE LICENSE FACILITY #

General Provider Information

NPI Number	:	1245605559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YMCA OF SAN DIEGO COUNTY

Provider Business Mailing Address
First Line	:	4451 30TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4232
Country	:	US
Telephone Number	:	619-281-8313
Fax Number	:

Provider Business Practice Location Address
First Line	:	3304 IDLEWILD WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3508
Country	:	US
Telephone Number	:	858-270-8213
Fax Number	:	858-270-8216

Authorized Official
Title or Position	:	ASSOCIATE EXECUTIVE DIRECTOR
Name	:	MS. KATIE DEMMLER
Credential	:
Telephone Number	:	619-281-8313

Provider Enumeration Date	:	12/11/2015
Last Update Date	:	01/09/2026

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Directions to “YMCA OF SAN DIEGO COUNTY ” Practice Location

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