Jack Gaines A Professional Corp.
Clinic/Center, Adult Mental Health in Encino, CA. Organization (NPI-2).
NPI number1619210291
StatusActive
Last updated in NPPESApr 1, 2013
Details
- NPI
- 1619210291
- Entity type
- Organization (NPI-2)
- Legal business name
- Jack Gaines A Professional Corp.
- Organization subpart
- No
- Enumeration date
- Apr 1, 2013
- Last updated
- Apr 1, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0850X | Clinic/Center, Adult Mental Health | c14269 | CA | Yes |
Practice location
4833 Rubio AveEncino, CA 91436-1118
Phone 818-981-4030
Mailing address
4833 Rubio AveEncino, CA 91436-1118
Authorized official
Jack W. Gaines
President
8189814030
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