Basic Information
| Provider Information | |||||||||
| NPI: | 1669854683 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERATEHOPE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4025 CAMINO DEL RIO S | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921084107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198184026 | ||||||||
| FaxNumber: | 6193427508 | ||||||||
| Practice Location | |||||||||
| Address1: | 3419 EVERGREEN RD | ||||||||
| Address2: | |||||||||
| City: | BONITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919021407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198184026 | ||||||||
| FaxNumber: | 6193427508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2015 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | MUNSEY | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | PATRICIA | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6198184026 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.