NPIMap

Organization Active NPI

Varsity Team, Incorporated

Doing business as Varsity Team #2

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • San Diego, CA
National Provider Identifier
1467029090
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
VARSITY TEAM, INCORPORATED
Doing business as
Varsity Team #2
Practice address
3027 Fleming Dr
San Diego, CA 92139-3714
Phone
(619) 512-1552
NPI assigned
Jun 10, 2021
Last updated
Jun 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

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

Authorized official

Name
Drew Dahlstedt
Title
Coo/Cfo
Phone
(619) 694-6809

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NU Primary

Addresses

Primary practice location

3027 Fleming Dr
San Diego, CA 92139-3714

Mailing address

PO Box 26633
San Diego, CA 92196-0633
Phone (619) 694-6809

Other names 1

  • Varsity Team #2 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Varsity Team 14 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623283200000",
    "number": "1467029090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26633",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921960633",
            "telephone_number": "619-694-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3027 FLEMING DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921393714",
            "telephone_number": "619-512-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VARSITY TEAM, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A",
        "authorized_official_last_name": "DAHLSTEDT",
        "authorized_official_first_name": "DREW",
        "authorized_official_title_or_position": "COO/CFO",
        "authorized_official_telephone_number": "619-694-6809"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Varsity Team #2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.