Provider Demographics
NPI:1043609969
Name:PREPARING PEOPLE FOR SUCCESS
Entity Type:Organization
Organization Name:PREPARING PEOPLE FOR SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-II
Authorized Official - Phone:916-575-8851
Mailing Address - Street 1:1513 SPORTS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1943
Mailing Address - Country:US
Mailing Address - Phone:916-575-8851
Mailing Address - Fax:
Practice Address - Street 1:1513 SPORTS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1943
Practice Address - Country:US
Practice Address - Phone:916-575-8851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121528933305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215287933OtherALCOHOL AND DRUG