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General NPI Number Information
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NPI Number | 1124200183
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Entity Type | Organization
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Legal Business Name | STEP UP ON SECOND
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 1328 2ND ST
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City | SANTA MONICA
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State | CA
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Zip | 90401-1122
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Country | US
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Telephone | 310-394-6889
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Fax | 310-395-0749
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Provider Business Mailing Address
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Address Line | 1328 2ND ST
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City | SANTA MONICA
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State | CA
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Zip | 90401-1122
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Country | US
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Telephone | 310-394-6889
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Fax | 310-395-0749
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Authorized Official
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Title or Position | STREET OUTREACH COORDINATOR
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Name | EDWARD PARKER
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Credential |
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Telephone | 310-394-6889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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