Provider Demographics
NPI:1265612246
Name:EAST COUNTY CENTER FOR CHANGE
Entity type:Organization
Organization Name:EAST COUNTY CENTER FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BURLEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-588-1989
Mailing Address - Street 1:1357 BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5811
Mailing Address - Country:US
Mailing Address - Phone:619-588-1989
Mailing Address - Fax:619-588-6282
Practice Address - Street 1:1357 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5811
Practice Address - Country:US
Practice Address - Phone:619-588-1989
Practice Address - Fax:619-588-6282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370069BN251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management