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Organization
MEN AND WOMEN OF PURPOSE
Active
Organization
MEN AND WOMEN OF PURPOSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICARDO JOSE FORTENBERRY B.S.H.S. CAS II (CHIEF EXECUTIVE OFFICER)
(510) 919-1302
Entity
Organization
Contact information
Practice address
3029 MACDONALD AVE, RICHMOND, CA 94804-3010
(510) 919-1302
(855) 691-9955
Mailing address
3029 MACDONALD AVE, RICHMOND, CA 94804-3010
(510) 919-1302
(855) 691-9955
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
01-005785
CA
Other
Enumeration date
09/19/2013
Last updated
09/19/2013
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