Organization
HOME AVENUE CTC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTAL GACHUPIN CATC (AOD COUNSELOR)
(619) 282-8000
Entity
Organization
Contact information
Practice address
3940 HOME AVE, SAN DIEGO, CA 92105-5952
(619) 282-8000
(619) 718-9897
Mailing address
3940 HOME AVE, SAN DIEGO, CA 92105-5952
(619) 282-8000
(619) 718-9897
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
C0502041556
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C0502041556
CCAPP
CA
Enumeration date
03/15/2016
Last updated
03/15/2016
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