Organization
MEN BUILDING MEN YOUTH FOUNDATION
Active
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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