Healthcare Provider Details

I. General information

NPI: 1235403668
Provider Name (Legal Business Name): U-TURN ALCOHOL & DRUG EDUCATION PROGRAM, INC,.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14401 S GIBSON AVE ROOM 37
COMPTON CA
90221-2514
US

IV. Provider business mailing address

3761 STOCKER ST SUITE 105
LOS ANGELES CA
90008-5111
US

V. Phone/Fax

Practice location:
  • Phone: 310-898-6070
  • Fax:
Mailing address:
  • Phone: 323-294-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE VARNADOE JR.
Title or Position: COO
Credential:
Phone: 323-294-4261