| NPI | 1184286288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGINA INES LAMPHERE SULLIVAN Owner 909-987-1997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2019-06-28 |