Provider Demographics
NPI:1023341344
Name:MANAGED CARE
Entity type:Organization
Organization Name:MANAGED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-283-9624
Mailing Address - Street 1:4775 VIEWRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1641
Mailing Address - Country:US
Mailing Address - Phone:858-565-4148
Mailing Address - Fax:858-565-4178
Practice Address - Street 1:4275 EL CAJON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1293
Practice Address - Country:US
Practice Address - Phone:619-283-9624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCIAL ADVOCATES FOR YOUTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-18
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty