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General NPI Number Information
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NPI Number | 1124517628
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Entity Type | Organization
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Legal Business Name | MEN TAKING OVER REFORMING SOCIETY INC
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 7907 S MARIPOSA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-2319
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Country | US
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Telephone | 323-338-6633
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Fax | 323-531-4326
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Provider Business Mailing Address
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Address Line | 7907 S MARIPOSA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90044-2319
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Country | US
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Telephone | 323-338-6633
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Fax | 323-531-4326
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TONI DENISE WELLS
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Credential | B.A.
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Telephone | 323-338-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | CA
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