1831223247 NPI number — UPAC ADDICTION TREATMENT AND RECOVERY CENTER

Table of content: (NPI 1831223247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831223247 NPI number — UPAC ADDICTION TREATMENT AND RECOVERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPAC ADDICTION TREATMENT AND RECOVERY CENTER
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:
1831223247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3288 EL CAJON BLVD STE 13
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:
92104-1430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-521-5720
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3288 EL CAJON BLVD.
Provider Second Line Business Practice Location Address:
SUITES 13, 12, 11, 10, 6, 3
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-521-5720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOATMAN
Authorized Official First Name:
COURTNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
619-521-5720

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3704 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com