Basic Information
| Provider Information | |||||||||
| NPI: | 1811129703 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CATHOLIC CHARITIES CYO OF THE ARCHDIOCESE OF SAN FRANCISCO | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SAN FRANCISCO BOYS' & GIRLS' HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 990 EDDY ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941097713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159721200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 727 GOLDEN GATE AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941023101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152413000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2009 | ||||||||
| LastUpdateDate: | 04/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | GALLAGHER | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4155072000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SFBGH-SATELLITE LOCATION | ||||||||
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| AuthorizedOfficialCredential: | M.ED | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 385650002 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.