Provider Demographics
NPI:1316206907
Name:AWARENESS PROGRAM
Entity Type:Organization
Organization Name:AWARENESS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WIKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-342-1233
Mailing Address - Street 1:45926 OASIS ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4559
Mailing Address - Country:US
Mailing Address - Phone:760-342-1233
Mailing Address - Fax:760-342-5344
Practice Address - Street 1:45926 OASIS ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4559
Practice Address - Country:US
Practice Address - Phone:760-342-1233
Practice Address - Fax:760-342-5344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty