Organization
THE WAY BACK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAM LEE BLASER I CAS (EXECUTIVE DIRECTOR)
(619) 235-0529
Entity
Organization
Contact information
Practice address
2516 A ST, SAN DIEGO, CA 92102-2111
(619) 235-0592
(619) 235-0593
Mailing address
2516 A ST, SAN DIEGO, CA 92102-2111
(619) 235-0592
(619) 235-0593
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
370011AN
CA
Other
Enumeration date
03/06/2007
Last updated
08/22/2020
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