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General NPI Number Information
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NPI Number | 1861229585
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Entity Type | Organization
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Legal Business Name | ON MY GRIND, RE-ENTRY SERVICES INC
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 3780 KILROY AIRPORT WAY STE 200
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City | LONG BEACH
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State | CA
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Zip | 90806-2458
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Country | US
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Telephone | 323-809-0386
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Fax |
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Provider Business Mailing Address
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Address Line | 3780 KILROY AIRPORT WAY STE 200
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City | LONG BEACH
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State | CA
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Zip | 90806-2458
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Country | US
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Telephone | 323-809-0386
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LV THOMAS
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Credential |
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Telephone | 323-809-0386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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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 | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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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 |
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