Organization
DIAMOND LODGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNIE MAYO JACOB (OWNER ADMINISTRATOR)
(415) 577-1004
Entity
Organization
Contact information
Practice address
20 ARLINGTON ST, SF, CA 94131
(415) 285-0688
Mailing address
1135 TOURNAMENT DRIVE, SF, CA 94131
(415) 285-0688
(415) 550-6492
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/30/2007
Last updated
11/30/2007
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