Provider Demographics
NPI:1780028274
Name:ADOLESCENT GUIDANCE SERVICES LLC
Entity type:Organization
Organization Name:ADOLESCENT GUIDANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-700-3300
Mailing Address - Street 1:231 MARKET PL # 194
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4743
Mailing Address - Country:US
Mailing Address - Phone:877-700-3300
Mailing Address - Fax:925-830-8720
Practice Address - Street 1:231 MARKET PL # 194
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4743
Practice Address - Country:US
Practice Address - Phone:877-700-3300
Practice Address - Fax:925-830-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)