=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932612264
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA PROJECT FOR THE HOMELESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2017
-----------------------------------------------------
Last Update Date | 11/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 975 POSTAL WAY
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92083-6945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-630-9922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 993 POSTAL WAY
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92083-6945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-403-8112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | JASON RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-630-9922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 370073AN
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------