Provider Demographics
NPI:1770967267
Name:SECOND2NONE
Entity type:Organization
Organization Name:SECOND2NONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:DUDEK
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-II, ICADC
Authorized Official - Phone:951-461-1800
Mailing Address - Street 1:32619 VIA PERALES
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8148
Mailing Address - Country:US
Mailing Address - Phone:951-587-1073
Mailing Address - Fax:
Practice Address - Street 1:32619 VIA PERALES
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-8148
Practice Address - Country:US
Practice Address - Phone:951-587-1073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1202970615324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility