Basic Information
| Provider Information | |||||||||
| NPI: | 1619393675 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONARD HOUSE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1385 MISSION ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158644002 | ||||||||
| FaxNumber: | 4158647093 | ||||||||
| Practice Location | |||||||||
| Address1: | 1385 MISSION ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158644002 | ||||||||
| FaxNumber: | 4158647093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2014 | ||||||||
| LastUpdateDate: | 03/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | MENDOZA | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
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| AuthorizedOfficialTitleorPosition: | AD-OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4158644002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | 89492 | CA | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.