| NPI | 1346804432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA SERRATOS Program Administrator 909-599-8222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2024-07-03 |