Provider Demographics
NPI:1770919946
Name:MEN AND WOMEN OF PURPOSE
Entity type:Organization
Organization Name:MEN AND WOMEN OF PURPOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:FORTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:BSHS CAS II
Authorized Official - Phone:510-919-1302
Mailing Address - Street 1:3029 MACDONALD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-3010
Mailing Address - Country:US
Mailing Address - Phone:510-919-1302
Mailing Address - Fax:855-691-9955
Practice Address - Street 1:3029 MACDONALD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-3010
Practice Address - Country:US
Practice Address - Phone:510-919-1302
Practice Address - Fax:855-691-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-005785101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty