Healthcare Provider Details

I. General information

NPI: 1437585791
Provider Name (Legal Business Name): READY4CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 WATT AVE SUITE #205
SACRAMENTO CA
95821-3602
US

IV. Provider business mailing address

3400 WATT AVE SUITE #205
SACRAMENTO CA
95821-3602
US

V. Phone/Fax

Practice location:
  • Phone: 916-821-9090
  • Fax:
Mailing address:
  • Phone: 916-821-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. LEO ANTHONY VASQUEZ I
Title or Position: PRESIDENT / CEO
Credential: B.S.W, RAS 11
Phone: 916-821-9090