| NPI | 1124250378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAZEL GERTRUDE ROBERTS Owner/President 909-623-3353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: CA 191501024) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: CA 360906027) |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: CA 191592141) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2009-08-20 |