MEDICARE: SAN DIEGO FOUNDATION FOR RECOVERY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171100000X	Acupuncturist
2	171M00000X	Case Manager/Care Coordinator
3	261Q00000X	Clinic/Center
4	261QI0500X	Infusion Therapy Clinic/Center
5	261QP2000X	Physical Therapy Clinic/Center
6	261QP2300X	Primary Care Clinic/Center
7	261QP3300X	Pain Clinic/Center
8	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
9	261QR0800X	Recovery Care Clinic/Center
10	261QS1200X	Sleep Disorder Diagnostic Clinic/Center
11	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1770756074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO FOUNDATION FOR RECOVERY

Provider Business Mailing Address
First Line	:	4241 JUTLAND DR
Second Line	:	103
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3663
Country	:	US
Telephone Number	:	858-490-3460
Fax Number	:	858-490-3462

Provider Business Practice Location Address
First Line	:	4241 JUTLAND DR
Second Line	:	103
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3663
Country	:	US
Telephone Number	:	858-490-3460
Fax Number	:	858-490-3462

Authorized Official
Title or Position	:	CEO
Name	:	MS. PHYLLIS MEAGHER
Credential	:
Telephone Number	:	858-490-3460

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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Directions to “SAN DIEGO FOUNDATION FOR RECOVERY ” Practice Location

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