MEDICARE: PREPARING PEOPLE FOR SUCCESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	121528933	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1215287933	OTHER	CA	ALCOHOL AND DRUG

General Provider Information

NPI Number	:	1043609969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREPARING PEOPLE FOR SUCCESS

Provider Business Mailing Address
First Line	:	1513 SPORTS DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1943
Country	:	US
Telephone Number	:	916-575-8851
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 SPORTS DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1943
Country	:	US
Telephone Number	:	916-575-8851
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHAWN VAUGHAN-WILLIAMS
Credential	:	CADC-II
Telephone Number	:	916-575-8851

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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Directions to “PREPARING PEOPLE FOR SUCCESS ” Practice Location

Language	Start Address	Practice Location

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