Organization
ADOLESCENCE'S LAST RESORT
Active
Other names
The Last Resort
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MIGNON NICOLE HEARST (OFFICE MANAGER)
(209) 523-6910
Entity
Organization
Contact information
Practice address
218 E. ORANGEBURG AVENUE, MODESTO, CA 95350
(209) 523-6900
(209) 523-6912
Mailing address
3125 MCHENRY AVENUE STE D., MODESTO, CA 95350
(209) 523-6910
(209) 523-6912
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
507004599
CA
Other
Enumeration date
01/12/2011
Last updated
08/07/2013
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