| NPI | 1497491450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHA AMICK Director Of Billing 909-382-7180 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2022-09-01 |