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General NPI Number Information
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NPI Number | 1699460022
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Entity Type | Organization
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Legal Business Name | GROUNDUP FOUNDATION INC
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 6100 DE SOTO AVE UNIT #426
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City | WOODLAND HILLS
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State | CA
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Zip | 91367
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Country | US
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Telephone | 323-337-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 20929 VENTURA BLVD STE 47
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-2334
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONNIE MCCLAIN
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Credential |
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Telephone | 323-337-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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