Organization
STEP UP ON SECOND ACT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE A. JENSEN M.S. (CLINICAL CASE MANGER)
(715) 212-6855
Entity
Organization
Contact information
Practice address
3435 OCEAN PARK BLVD, SANTA MONICA, CA 90405-3301
(310) 392-9474
Mailing address
3435 OCEAN PARK BLVD, SANTA MONICA, CA 90405-3301
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
07/31/2008
Last updated
07/31/2008
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