| NPI | 1316125081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUBREY ANCIL KING CFO/ Medical Director 909-946-0707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: CA G56023) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility (Licence: CA G56023) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2008-06-23 |