Healthcare Provider Details

I. General information

NPI: 1861229585
Provider Name (Legal Business Name): ON MY GRIND, RE-ENTRY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 KILROY AIRPORT WAY STE 200
LONG BEACH CA
90806-2458
US

IV. Provider business mailing address

3780 KILROY AIRPORT WAY STE 200
LONG BEACH CA
90806-2458
US

V. Phone/Fax

Practice location:
  • Phone: 323-809-0386
  • Fax:
Mailing address:
  • Phone: 323-809-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LV THOMAS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 323-809-0386