| Logan Heights Family Counseling Center | |
|
2204 National Ave San Diego CA 92113-3615 | |
| (619) 515-2355 | |
| (619) 232-7011 |
| Full Name | Logan Heights Family Counseling Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2204 National Ave, San Diego, California |
| Authorized Official Name and Position | Ricardo Roman (CFO) |
| Authorized Official Contact | 6195152300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Logan Heights Family Counseling Center 823 Gateway Center Way San Diego CA 92102-4541 Ph: (619) 515-2300 | Logan Heights Family Counseling Center 2204 National Ave San Diego CA 92113-3615 Ph: (619) 515-2355 |
| NPI Number | 1013952597 |
|---|---|
| Provider Enumeration Date | 06/18/2006 |
| Last Update Date | 02/20/2024 |
| Medicare PECOS PAC ID | 3476446378 |
|---|---|
| Medicare Enrollment ID | O20051216000647 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013952597 | NPI | - | NPPES |
| FHC71076F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550000024 (California) | Primary |
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