Provider Demographics
NPI:1285396622
Name:DISADVANTAGED DISABLED MINORITIES FOUNDATION
Entity type:Organization
Organization Name:DISADVANTAGED DISABLED MINORITIES FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCCLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-321-1807
Mailing Address - Street 1:590 FARRINGTON HWY PMB 210-274
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-321-1807
Mailing Address - Fax:
Practice Address - Street 1:20355 SHERMAN WAY CANOGA PARK
Practice Address - Street 2:
Practice Address - City:CANGO PK
Practice Address - State:CA
Practice Address - Zip Code:91306
Practice Address - Country:US
Practice Address - Phone:818-357-8541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities