Provider Demographics
NPI:1124517628
Name:MEN TAKING OVER REFORMING SOCIETY INC
Entity type:Organization
Organization Name:MEN TAKING OVER REFORMING SOCIETY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:323-338-6633
Mailing Address - Street 1:7907 S MARIPOSA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2319
Mailing Address - Country:US
Mailing Address - Phone:323-338-6633
Mailing Address - Fax:323-531-4326
Practice Address - Street 1:7907 S MARIPOSA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2319
Practice Address - Country:US
Practice Address - Phone:323-338-6633
Practice Address - Fax:323-531-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X, 347C00000X
CA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle