| NPI | 1619366952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA M REESE Director 909-229-4312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA LCS9548) |
| Additional Taxonomies | 251S00000X (Licence: CA LCS9548) |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2015-01-12 |