| NPI | 1548962954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CONNARD Program Director 909-461-0960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2024-01-18 |