Provider Demographics
NPI:1861212102
Name:MENTAL HEALTH CENTER OF SAN DIEGO
Entity type:Organization
Organization Name:MENTAL HEALTH CENTER OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-933-1931
Mailing Address - Street 1:960 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4041
Mailing Address - Country:US
Mailing Address - Phone:949-836-6793
Mailing Address - Fax:
Practice Address - Street 1:6372 ROCKHURST DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3803
Practice Address - Country:US
Practice Address - Phone:949-836-6793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility