Healthcare Provider Details

I. General information

NPI: 1407008956
Provider Name (Legal Business Name): U-TURN ALCOHOL & DRUG ED. PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3761 STOCKER ST
LOS ANGELES CA
90008-5111
US

IV. Provider business mailing address

3761 STOCKER ST
LOS ANGELES CA
90008-5111
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JANICE VARNADOE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 323-294-4261