1689897100 NPI number — COMMUNITY RESEARCH FOUNDATION INC

Table of content: (NPI 1689897100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689897100 NPI number — COMMUNITY RESEARCH FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY RESEARCH FOUNDATION INC
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:
DOUGLAS YOUNG YOUTH AND FAMILY SERVICES
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:
1689897100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7917 OSTROW ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92111-3604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-300-8282
Provider Business Mailing Address Fax Number:
858-300-8284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7917 OSTROW ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-300-8282
Provider Business Practice Location Address Fax Number:
858-300-8284
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARCHETTI
Authorized Official First Name:
BOB
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
619-275-0822

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  37H5 , 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: 37H5 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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