Provider Demographics
NPI:1275991887
Name:READY4CHANGE
Entity Type:Organization
Organization Name:READY4CHANGE
Other - Org Name:GRANT HIGH SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:A
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:916-821-9090
Mailing Address - Street 1:1221 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-4464
Mailing Address - Country:US
Mailing Address - Phone:916-566-3450
Mailing Address - Fax:
Practice Address - Street 1:1221 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-4464
Practice Address - Country:US
Practice Address - Phone:916-566-3450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty