Organization
POWERED BY GRATITUDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARON CHRISTOPHER RANDOLPH JR. (EXECUTIVE DIRECTOR)
(323) 677-1724
Entity
Organization
Contact information
Practice address
6071 GOLD SPIRIT ST, EASTVALE, CA 92880-0989
(323) 677-1724
Mailing address
6071 GOLD SPIRIT ST, EASTVALE, CA 92880-0989
(323) 677-1724
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
Primary
—
—
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
405300000X
Prevention Professional
—
—
Other
Enumeration date
03/25/2025
Last updated
03/25/2025
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