Organization
MEN BUILDING MEN YOUTH FOUNDATION
Active
Other names
Peak Performance Outpatient Services
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH RICHARD (COMPANYS PRESIDENT)
(323) 447-7609
Entity
Organization
Contact information
Practice address
10813 CRENSHAW BLVD, INGLEWOOD, CA 90303-2007
(323) 447-7609
Mailing address
10813 CRENSHAW BLVD, INGLEWOOD, CA 90303-2007
(323) 447-7609
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
190590BN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190590BN
MEDICAL
CA
Enumeration date
06/09/2008
Last updated
06/09/2008
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