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General NPI Number Information
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NPI Number | 1336474386
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Entity Type | Organization
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Legal Business Name | PROJECT AMEND, INC.
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 10/08/2009
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Provider Practice Location Address
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Address Line | 657 SWEENEY LN
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6719
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Country | US
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Telephone | 805-782-9600
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Fax | 805-782-9602
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Provider Business Mailing Address
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Address Line | 657 SWEENEY LN
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6719
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Country | US
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Telephone | 805-782-9600
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Fax | 805-782-9602
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MICHAEL AXELROD
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Credential | CADCII, ICADC, CCPS
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Telephone | 805-782-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 400007AN
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License Number State | CA
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