Provider Demographics
NPI:1386123719
Name:ALCOHOL & DRUG AWARENESS PROGRAM
Entity type:Organization
Organization Name:ALCOHOL & DRUG AWARENESS PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BENNER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:209-870-6500
Mailing Address - Street 1:PO BOX 5070
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-0070
Mailing Address - Country:US
Mailing Address - Phone:209-870-6500
Mailing Address - Fax:209-337-2108
Practice Address - Street 1:1981 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-2720
Practice Address - Country:US
Practice Address - Phone:209-870-6500
Practice Address - Fax:209-474-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility