Healthcare Provider Details

I. General information

NPI: 1720424948
Provider Name (Legal Business Name): PLAY POLY-MODAL LEARNING FOR ASD YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 MOUNTAIN SPRINGS DR.
TURLOCK CA
95382
US

IV. Provider business mailing address

2411 MOUNTAIN SPRINGS DR.
TURLOCK CA
95382
US

V. Phone/Fax

Practice location:
  • Phone: 209-606-2091
  • Fax: 213-567-4993
Mailing address:
  • Phone: 209-606-2091
  • Fax: 213-567-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEONORA MARY JAHNER
Title or Position: OWNER OF P.L.A.Y.
Credential:
Phone: 209-606-2091