Healthcare Provider Details

I. General information

NPI: 1356880967
Provider Name (Legal Business Name): YOU ARE THE DIFFERENCE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S BURRIS AVE
COMPTON CA
90221-3945
US

IV. Provider business mailing address

1249 S DIAMOND BAR BLVD
DIAMOND BAR CA
91765-4122
US

V. Phone/Fax

Practice location:
  • Phone: 310-608-0150
  • Fax: 310-608-6920
Mailing address:
  • Phone: 909-861-2809
  • Fax: 909-396-4429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: BILLIE WOODS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-608-0150