Provider Demographics
NPI:1982062501
Name:READY4CHANGE
Entity Type:Organization
Organization Name:READY4CHANGE
Other - Org Name:RIO LINDA HIGH SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:916-821-9090
Mailing Address - Street 1:6309 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-4412
Mailing Address - Country:US
Mailing Address - Phone:916-566-2725
Mailing Address - Fax:
Practice Address - Street 1:6309 DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:RIO LINDA
Practice Address - State:CA
Practice Address - Zip Code:95673-4412
Practice Address - Country:US
Practice Address - Phone:916-566-2725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty