Healthcare Provider Details

I. General information

NPI: 1366395105
Provider Name (Legal Business Name): JAIL GUITAR DOORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7946 W 3RD ST
LOS ANGELES CA
90048-4305
US

IV. Provider business mailing address

842 N FAIRFAX AVE
LOS ANGELES CA
90046-7208
US

V. Phone/Fax

Practice location:
  • Phone: 516-244-3021
  • Fax:
Mailing address:
  • Phone: 323-852-0457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1744G0900X
TaxonomyGraphics Designer
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JASON HEATH SNYDER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 323-600-5854