Basic Information
| Provider Information | |||||||||
| NPI: | 1609184035 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PROJECT ENABLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 286 EUCLID AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921143611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192662111 | ||||||||
| FaxNumber: | 6192660496 | ||||||||
| Practice Location | |||||||||
| Address1: | 286 EUCLID AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921143611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192662111 | ||||||||
| FaxNumber: | 6192660496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2010 | ||||||||
| LastUpdateDate: | 09/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | JAIME | ||||||||
| AuthorizedOfficialFirstName: | EVELINA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6192662111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEIGHBORHOOD HOUSE ASSOCIATION | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.