Healthcare Provider Details

I. General information

NPI: 1124517628
Provider Name (Legal Business Name): MEN TAKING OVER REFORMING SOCIETY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7907 S MARIPOSA AVE
LOS ANGELES CA
90044-2319
US

IV. Provider business mailing address

7907 S MARIPOSA AVE
LOS ANGELES CA
90044-2319
US

V. Phone/Fax

Practice location:
  • Phone: 323-338-6633
  • Fax: 323-531-4326
Mailing address:
  • Phone: 323-338-6633
  • Fax: 323-531-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: TONI DENISE WELLS
Title or Position: EXECUTIVE DIRECTOR
Credential: B.A.
Phone: 323-338-6633