Organization
ADOLESCENCE'S LAST RESORT
Active
Other names
The Last Resort
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE DENISE LUCAS (ADMINISTRATOR)
(209) 523-6900
Entity
Organization
Contact information
Practice address
3125 MCHENRY AVE, SUITE D, MODESTO, CA 95350-1451
(209) 523-6900
Mailing address
3125 MCHENRY AVE, SUITE D, MODESTO, CA 95350-1451
(209) 523-6900
Taxonomy
Speciality
Code
Description
License number
State
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
Primary
50010AN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500010AN
ALCOHOL AND DRUG PROGRAMS
CA
01
—
5041
DRUG MEDI-CAL
CA
01
—
507004599
DEPARTMENT OF SOCIAL SERVICES, CHILDRENS RESIDENTIAL PROGRAM
CA
Enumeration date
06/15/2011
Last updated
04/10/2012
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