Provider Demographics
NPI:1548386626
Name:PROJECT RETURN PEER SUPPORT NETWORK
Entity Type:Organization
Organization Name:PROJECT RETURN PEER SUPPORT NETWORK
Other - Org Name:PROJECT RETURN THE NEXT STEP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:COLANTUONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-346-0960
Mailing Address - Street 1:2677 ZOE AVE SUITE #304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4195
Mailing Address - Country:US
Mailing Address - Phone:323-346-0960
Mailing Address - Fax:323-346-0966
Practice Address - Street 1:2677 ZOE AVE SUITE #304
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4195
Practice Address - Country:US
Practice Address - Phone:323-346-0960
Practice Address - Fax:323-346-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X, 251S00000X
CANA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty