Basic Information
| Provider Information | |||||||||
| NPI: | 1952617102 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY RESEARCH FGOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2122 CRANDALL DR | ||||||||
| Address2: | APT# C | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921116728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583574599 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1202 MORENA BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192750822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2010 | ||||||||
| LastUpdateDate: | 08/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | HSEINO | ||||||||
| AuthorizedOfficialFirstName: | KHALED | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERN | ||||||||
| AuthorizedOfficialTelephone: | 8583574599 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.