Organization
ALCOHOL & DRUG AWARENESS PROGRAM
Active
Other names
new direction
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE LAWRENCE BENNER BS (EXECUTIVE DIRECTOR)
(209) 870-6500
Entity
Organization
Contact information
Practice address
1981 CHEROKEE RD, STOCKTON, CA 95205-2720
(209) 870-6500
(209) 474-0697
Mailing address
PO BOX 5070, STOCKTON, CA 95205-0070
(209) 870-6500
(209) 337-2108
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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