Organization
CLUB STAFFING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAKE NYBORN (RECRUITER)
(800) 875-8999
Entity
Organization
Contact information
Practice address
5435 KESTER AVE APT 210, SHERMAN OAKS, CA 91411-3778
(508) 259-2125
Mailing address
5435 KESTER AVE APT 210, SHERMAN OAKS, CA 91411-3778
(508) 259-2125
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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