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General NPI Number Information
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NPI Number | 1043074388
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Entity Type | Organization
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Legal Business Name | OUR DAUGHTERS DESTINY ASSISTANCE PROGRAM
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 5330 MADISON AVE STE D
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City | SACRAMENTO
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State | CA
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Zip | 95841-3150
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Country | US
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Telephone | 916-720-1314
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 379
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City | NORTH HIGHLANDS
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State | CA
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Zip | 95660-0379
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Country | US
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Telephone | 916-720-1314
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHERELL HOWZE
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Credential |
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Telephone | 916-720-1314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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