1366597601 NPI number — THERAPEUTIC BEHAVIORAL SERVICES

Table of content: (NPI 1366597601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366597601 NPI number — THERAPEUTIC BEHAVIORAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC BEHAVIORAL SERVICES
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:
Provider Other Organization Name Type Code:
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:
1366597601
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:
PO BOX 85524
Provider Second Line Business Mailing Address:
MS P-503
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92186-5524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-401-4630
Provider Business Mailing Address Fax Number:
619-401-4627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92021-4899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-401-4630
Provider Business Practice Location Address Fax Number:
619-401-4627
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AGUIRRE
Authorized Official First Name:
ALFREDO
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY DIRECTOR MENTAL HEALTH SRVC
Authorized Official Telephone Number:
619-563-2711

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37ED , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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