Provider Demographics
NPI:1720653553
Name:THE TEEN PROJECT, INC.
Entity Type:Organization
Organization Name:THE TEEN PROJECT, INC.
Other - Org Name:VERA'S SANCTUARY 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-283-1260
Mailing Address - Street 1:8140 SUNLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-3948
Mailing Address - Country:US
Mailing Address - Phone:949-283-1260
Mailing Address - Fax:818-582-8836
Practice Address - Street 1:20302 FLANAGAN ROAD
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-0975
Practice Address - Country:US
Practice Address - Phone:949-283-1260
Practice Address - Fax:818-582-8836
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE TEEN PROJECT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-24
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care