1487878831 NPI number — CITY & COUNTY OF SAN FRANCISCO

Table of content: (NPI 1487878831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487878831 NPI number — CITY & COUNTY OF SAN FRANCISCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY & COUNTY OF SAN FRANCISCO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OBOT-POTRERO HILL HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487878831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 POTRERO AVE
Provider Second Line Business Mailing Address:
SAN FRANCISCO GENERAL HOSPITAL, PSYCH ADMIN., 7M17
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94110-3518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-206-4550
Provider Business Mailing Address Fax Number:
415-206-8942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 WISCONSIN ST
Provider Second Line Business Practice Location Address:
POTRERO HILL HEALTH CENTER
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94107-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-648-3022
Provider Business Practice Location Address Fax Number:
415-550-1639
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WICHER
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
MCCOLE
Authorized Official Title or Position:
DIRECTOR, BEHAVIORAL HEALTH
Authorized Official Telephone Number:
415-206-6569

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , with the licence number:  38-07B , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3883 . This is a "SHORT-DOYLE MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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