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NPI Code Detail

MEDICARE: GLOM SUBSTANCE ABUSE PROGRAM

MEDICARE: GLOM SUBSTANCE ABUSE PROGRAM
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

General Provider Information

NPI Number : 1629755970
Entity Type Code : Organization
Provider Name (Legal Business Name) : GLOM SUBSTANCE ABUSE PROGRAM
Provider Business Mailing Address
First Line : 3131 INDEPENDENCE DR
Second Line :
City : LIVERMORE
State : CA
Zip : 94551-7595
Country : US
Telephone Number : 925-570-3282
Fax Number :
Provider Business Practice Location Address
First Line : 130 W FLORA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1636
Country : US
Telephone Number : 925-334-7186
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DR. ALLEN TURNER
Credential :
Telephone Number : 925-570-3282
Provider Enumeration Date : 06/29/2023
Last Update Date : 08/22/2024

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Directions to “GLOM SUBSTANCE ABUSE PROGRAM ” Practice Location

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