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NPI Code Detail

MEDICARE: GLOM OUTPATIENT SERVICES INC.

MEDICARE: GLOM OUTPATIENT SERVICES INC.
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2171M00000XCase Manager/Care Coordinator
3261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1417537366
Entity Type Code : Organization
Provider Name (Legal Business Name) : GLOM OUTPATIENT SERVICES INC.
Provider Business Mailing Address
First Line : 3123 INDEPENDENCE DR
Second Line :
City : LIVERMORE
State : CA
Zip : 94551-7595
Country : US
Telephone Number : 925-999-4119
Fax Number : 925-800-3102
Provider Business Practice Location Address
First Line : 130 W FLORA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1636
Country : US
Telephone Number : 844-456-6677
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DR. ALLEN TURNER
Credential :
Telephone Number : 925-570-3282
Provider Enumeration Date : 04/13/2021
Last Update Date : 02/24/2026

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