Basic Information
| Provider Information | |||||||||
| NPI: | 1811040470 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FELTON INSTITUTE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FAMILY SERVICE AGENCY OF SAN FRANCISCO | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 LAUREL AVE | ||||||||
| Address2: | |||||||||
| City: | HALF MOON BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940191675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153866600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6221 GEARY BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941211821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153866600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 02/14/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | MARVIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL & OPERATIONS OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 4154747310 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | BBSMFC43102 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.