NPIMap

Organization Active NPI

San Diego Health Alliance

Doing business as El Cajon Treatment Center

  • Methadone Clinic
  • El Cajon, CA
National Provider Identifier
1386753655
Registry record updated Mar 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
37-09 Issued in CA
Legal business name
SAN DIEGO HEALTH ALLIANCE
Doing business as
El Cajon Treatment Center
Practice address
234 N Magnolia Ave
El Cajon, CA 92020-3906
Phone
(619) 579-8378
Fax
(619) 579-8155
NPI assigned
Aug 30, 2006
Last updated
Mar 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kim Sanderson
Title
President CTC Division
Phone
(855) 259-2288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X 37-09 CA Primary

Addresses

Primary practice location

234 N Magnolia Ave
El Cajon, CA 92020-3906

Mailing address

6185 Paseo del Norte, Ste 150
Carlsbad, CA 92011-1155
Phone (855) 259-2288

Other names 1

  • El Cajon Treatment Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200121000541 CA Part B Supplier - Opioid Treatment Program (Otp) 4183059116 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: El Cajon, CA; San Diego, CA; San Marcos, CA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Home Avenue CTC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583971200000",
    "number": "1386753655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6185 PASEO DEL NORTE, STE 150",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920111155",
            "telephone_number": "855-259-2288",
            "fax_number": "619-579-8155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 N MAGNOLIA AVE",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920203906",
            "telephone_number": "619-579-8378",
            "fax_number": "619-579-8155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A",
        "authorized_official_last_name": "SANDERSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PRESIDENT CTC DIVISION",
        "authorized_official_telephone_number": "855-259-2288"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "CA",
            "license": "37-09",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Cajon Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "El Cajon Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Cajon, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.