Organization
CRC HOME AVENUE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDEE RICHARDSON MS (PROGRAM DIRECTOR)
(619) 262-8000
Entity
Organization
Contact information
Practice address
3940 HOME AVE, SAN DIEGO, CA 92105-5952
(619) 262-8800
(619) 266-7405
Mailing address
3940 HOME AVE, SAN DIEGO, CA 92105-5952
(619) 262-8800
(619) 266-7405
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
37-07
CA
Other
Enumeration date
10/12/2012
Last updated
10/12/2012
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