Provider Demographics
NPI:1700900594
Name:TERECOR FOUNDATION CORPORATION
Entity Type:Organization
Organization Name:TERECOR FOUNDATION CORPORATION
Other - Org Name:TERECOR FOUNDATION'S SUBSTANCE ABUSE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J.D.
Authorized Official - Middle Name:(NMN)
Authorized Official - Last Name:REED,
Authorized Official - Suffix:JR
Authorized Official - Credentials:DV COUNSELOR
Authorized Official - Phone:310-639-0107
Mailing Address - Street 1:544 W ROSECRANS AVE
Mailing Address - Street 2:P.O. BOX 5245
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-3944
Mailing Address - Country:US
Mailing Address - Phone:310-639-0107
Mailing Address - Fax:310-639-0119
Practice Address - Street 1:544 W ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-3944
Practice Address - Country:US
Practice Address - Phone:310-639-0107
Practice Address - Fax:310-639-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190466AOD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty