Provider Demographics
NPI:1255705703
Name:SAN DIEGO CARE PLACEMENT, INC.
Entity type:Organization
Organization Name:SAN DIEGO CARE PLACEMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-660-8814
Mailing Address - Street 1:3691 VIA MERCADO
Mailing Address - Street 2:SUITE 16
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-8325
Mailing Address - Country:US
Mailing Address - Phone:619-660-8814
Mailing Address - Fax:619-660-8815
Practice Address - Street 1:3691 VIA MERCADO
Practice Address - Street 2:SUITE 16
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-8325
Practice Address - Country:US
Practice Address - Phone:619-660-8814
Practice Address - Fax:619-660-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management