Provider Demographics
NPI:1053576694
Name:SALVATION ARMY HARBOR LIGHT CENTER
Entity type:Organization
Organization Name:SALVATION ARMY HARBOR LIGHT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-503-3001
Mailing Address - Street 1:1275 HARRISON STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103
Mailing Address - Country:US
Mailing Address - Phone:415-503-3001
Mailing Address - Fax:415-861-4261
Practice Address - Street 1:1275 HARRISON STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103
Practice Address - Country:US
Practice Address - Phone:415-503-3001
Practice Address - Fax:415-861-4261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SALVATION ARMY WESTERN USA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-23
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380006AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility