| NPI | 1538399191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALFONSO A LOTA Administrator 909-591-0791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: CA 360911118) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2009-07-17 |