Provider Demographics
NPI:1902931892
Name:PACIFIC PRIDE FOUNDATION
Entity Type:Organization
Organization Name:PACIFIC PRIDE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-963-3636
Mailing Address - Street 1:126 E HALEY ST
Mailing Address - Street 2:SUITE A-11
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2342
Mailing Address - Country:US
Mailing Address - Phone:805-963-3636
Mailing Address - Fax:805-963-9086
Practice Address - Street 1:126 E HALEY ST
Practice Address - Street 2:SUITE A-11
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2342
Practice Address - Country:US
Practice Address - Phone:805-963-3636
Practice Address - Fax:805-963-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAYD000390OtherMEDICAL ID NUMBER
CAAYD000390OtherMEDICAL ID NUMBER