| NPI | 1518317205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY CHRISTENSEN Administrator 909-425-5372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: CA 366427412) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: CA 366427413) |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: CA 366427414) | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2016-06-14 |