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Organization
THE FORUM AT SAN DIEGO BRAINWORKS, INC.
Active
Organization
THE FORUM AT SAN DIEGO BRAINWORKS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAHAN SUZMEYAN (COMPLIANCE)
(213) 924-6442
Entity
Organization
Contact information
Practice address
5820 OBERLIN DR STE 203, SAN DIEGO, CA 92121-3744
(858) 247-3162
Mailing address
5820 OBERLIN DR STE 203, SAN DIEGO, CA 92121-3744
(858) 247-3162
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
04/14/2022
Last updated
04/14/2022
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