Provider Demographics
NPI:1205209749
Name:ADOLESCENT ACADEMY, INC.
Entity Type:Organization
Organization Name:ADOLESCENT ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-698-7612
Mailing Address - Street 1:PO BOX 1033
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92564-1033
Mailing Address - Country:US
Mailing Address - Phone:951-698-7612
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR STE 117G
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2647
Practice Address - Country:US
Practice Address - Phone:951-698-7612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children