Provider Demographics
NPI:1194984005
Name:FREE N ONE A DRUG AND ALCOHOL FREE PROGRAM
Entity type:Organization
Organization Name:FREE N ONE A DRUG AND ALCOHOL FREE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-295-0095
Mailing Address - Street 1:5838 OVERHILL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2725
Mailing Address - Country:US
Mailing Address - Phone:323-295-0095
Mailing Address - Fax:
Practice Address - Street 1:5838 OVERHILL DR
Practice Address - Street 2:STE 3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2725
Practice Address - Country:US
Practice Address - Phone:323-295-0095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190447BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility