Provider Demographics
NPI:1649817842
Name:THE SOCIAL WORK ACTION GROUP
Entity type:Organization
Organization Name:THE SOCIAL WORK ACTION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN HORN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:909-234-2846
Mailing Address - Street 1:28497 CALIFORNIA 74 SUITE 113
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532
Mailing Address - Country:US
Mailing Address - Phone:833-792-4674
Mailing Address - Fax:951-609-2001
Practice Address - Street 1:28497 CALIFORNIA 74 SUITE 113
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532
Practice Address - Country:US
Practice Address - Phone:833-792-4674
Practice Address - Fax:951-609-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty