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General NPI Number Information
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NPI Number | 1700900594
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Entity Type | Organization
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Legal Business Name | TERECOR FOUNDATION CORPORATION
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Dates
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Enumeration Date | 03/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 544 W ROSECRANS AVE
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City | COMPTON
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State | CA
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Zip | 90222-3944
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Country | US
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Telephone | 310-639-0107
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Fax | 310-639-0119
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Provider Business Mailing Address
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Address Line | 544 W ROSECRANS AVE P.O. BOX 5245
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City | COMPTON
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State | CA
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Zip | 90222-3944
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Country | US
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Telephone | 310-639-0107
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Fax | 310-639-0119
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. J.D. (NMN) REED, JR.
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Credential | D.V. COUNSELOR
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Telephone | 310-639-0107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 190466AOD
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License Number State | CA
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