Provider Demographics
NPI:1609073691
Name:TRANSITIONS-MENTAL HEALTH ASSOCIATION
Entity type:Organization
Organization Name:TRANSITIONS-MENTAL HEALTH ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLSTER-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-541-5144
Mailing Address - Street 1:PO BOX 15408
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-5408
Mailing Address - Country:US
Mailing Address - Phone:805-541-5144
Mailing Address - Fax:805-541-9480
Practice Address - Street 1:1511 OSOS ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4037
Practice Address - Country:US
Practice Address - Phone:805-541-0107
Practice Address - Fax:805-544-0741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSITIONS-MENTAL HEALTH ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-02
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405801098320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness