Healthcare Provider Details

I. General information

NPI: 1609637941
Provider Name (Legal Business Name): GUIDANCE 2 GREATNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 PATRICIA AVE APT 316
SIMI VALLEY CA
93065-7558
US

IV. Provider business mailing address

2551 GALENA AVE # 1232
SIMI VALLEY CA
93065-1305
US

V. Phone/Fax

Practice location:
  • Phone: 503-575-7612
  • Fax:
Mailing address:
  • Phone: 310-867-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training 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 Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE JEFFERSON
Title or Position: CEO & PRESIDENT
Credential:
Phone: 310-867-3925