Organization
KIVA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHARON CELESTE JOHNSON I (ADMINISTRATIVE ASSISTANT)
(619) 655-9897
Entity
Organization
Contact information
Practice address
2049 SKYLINE DR, LEMON GROVE, CA 91945-4221
(619) 465-7303
Mailing address
2049 SKYLINE DR, LEMON GROVE, CA 91945-4221
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/07/2013
Last updated
11/07/2013
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