Provider Demographics
NPI:1184960478
Name:DRK CO
Entity type:Organization
Organization Name:DRK CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:KRISHUN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW523CBD9511
Authorized Official - Phone:310-530-9475
Mailing Address - Street 1:1785 SAHARA AVE
Mailing Address - Street 2:STE 490-983
Mailing Address - City:LOS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104
Mailing Address - Country:US
Mailing Address - Phone:800-829-4933
Mailing Address - Fax:310-530-9475
Practice Address - Street 1:22930 CRENSHAW BLVD.
Practice Address - Street 2:STE A-2
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:323-345-4969
Practice Address - Fax:310-530-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52395111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty