| Sa3-fsp Program | |
|
1359 N Grand Ave Covina CA 91724-1016 | |
| (626) 430-2800 | |
| Not Available |
| Full Name | Sa3-fsp Program |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1359 N Grand Ave, Covina, California |
| Authorized Official Name and Position | Lisa H. Wong (ACTING DIRECTOR) |
| Authorized Official Contact | 2137384601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sa3-fsp Program 510 S Vermont Ave Los Angeles CA 90020-1992 Ph: (213) 738-4601 | Sa3-fsp Program 1359 N Grand Ave Covina CA 91724-1016 Ph: (626) 430-2800 |
| NPI Number | 1649490475 |
|---|---|
| Provider Enumeration Date | 04/26/2007 |
| Last Update Date | 08/04/2022 |
| Certification Date | 08/04/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649490475 | NPI | - | NPPES |
| 7705 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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