Provider Demographics
NPI:1467298505
Name:ALCOHOL & DRUG AWARENESS PROGRAM
Entity type:Organization
Organization Name:ALCOHOL & DRUG AWARENESS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-610-9983
Mailing Address - Street 1:1981 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-2720
Mailing Address - Country:US
Mailing Address - Phone:209-610-9983
Mailing Address - Fax:
Practice Address - Street 1:1981 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-2720
Practice Address - Country:US
Practice Address - Phone:209-610-9983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility