Provider Demographics
NPI:1801248554
Name:MAAC ON ANTI-POVERTY OF SAN DIEGO COUNTY, INC
Entity type:Organization
Organization Name:MAAC ON ANTI-POVERTY OF SAN DIEGO COUNTY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:619-262-4002
Mailing Address - Street 1:1355 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4302
Mailing Address - Country:US
Mailing Address - Phone:619-426-3595
Mailing Address - Fax:619-426-0034
Practice Address - Street 1:73 N 2ND AVE STE B
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1124
Practice Address - Country:US
Practice Address - Phone:619-426-4801
Practice Address - Fax:619-426-0034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAAC ON ANTI-POVERTY OF SAN DIEGO COUNTY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-06
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370014BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility