MEDICARE: SAN DIEGO YOUTH SERVICES

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	253J00000X	Foster Care Agency	370090DN	CA

General Provider Information

NPI Number	:	1558548669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO YOUTH SERVICES

Provider Business Mailing Address
First Line	:	3255 WING ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-4638
Country	:	US
Telephone Number	:	619-221-8600
Fax Number	:	619-221-8611

Provider Business Practice Location Address
First Line	:	3255 WING ST STE 500
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-4642
Country	:	US
Telephone Number	:	619-221-8610
Fax Number	:	619-221-8619

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. WALTER PHILIPS
Credential	:
Telephone Number	:	619-221-8600

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	04/04/2013

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Directions to “SAN DIEGO YOUTH SERVICES ” Practice Location

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