Basic Information
| Provider Information | |||||||||
| NPI: | 1164889929 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EPISCOPAL COMMUNITY SERVICES | ||||||||
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| OtherOrganizationName: | ECS ACCORD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 MILE OF CARS WAY | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | NATIONAL CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919506610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192282800 | ||||||||
| FaxNumber: | 6192282801 | ||||||||
| Practice Location | |||||||||
| Address1: | 7474 EL CAJON BLVD | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919427420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197418147 | ||||||||
| FaxNumber: | 6197418139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2016 | ||||||||
| LastUpdateDate: | 12/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | MARICS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6192282800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 3700102120 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.