Provider Demographics
NPI:1316787377
Name:FIGHTING BACK SANTA MARIA VALLEY
Entity type:Organization
Organization Name:FIGHTING BACK SANTA MARIA VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, MDR
Authorized Official - Phone:805-346-1774
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456-0184
Mailing Address - Country:US
Mailing Address - Phone:805-346-1774
Mailing Address - Fax:805-621-5859
Practice Address - Street 1:201 S MILLER ST STE 209
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5249
Practice Address - Country:US
Practice Address - Phone:805-720-6220
Practice Address - Fax:805-621-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage