Provider Demographics
NPI:1295492346
Name:STOCKTONIANS TAKING ACTION TO NEUTRALIZE DRUGS
Entity type:Organization
Organization Name:STOCKTONIANS TAKING ACTION TO NEUTRALIZE DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-937-7625
Mailing Address - Street 1:1209 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-2208
Mailing Address - Country:US
Mailing Address - Phone:209-937-7625
Mailing Address - Fax:209-939-9347
Practice Address - Street 1:1209 E 8TH ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-2208
Practice Address - Country:US
Practice Address - Phone:209-937-7625
Practice Address - Fax:209-939-9347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage