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General NPI Number Information
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NPI Number | 1386123719
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Entity Type | Organization
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Legal Business Name | ALCOHOL & DRUG AWARENESS PROGRAM
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 1981 CHEROKEE RD
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City | STOCKTON
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State | CA
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Zip | 95205-2720
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Country | US
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Telephone | 209-870-6500
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Fax | 209-474-0697
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Provider Business Mailing Address
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Address Line | PO BOX 5070
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City | STOCKTON
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State | CA
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Zip | 95205-0070
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Country | US
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Telephone | 209-870-6500
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Fax | 209-337-2108
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DALE LAWRENCE BENNER
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Credential | BS
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Telephone | 209-870-6500
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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 |
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License Number State |
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