| NPI | 1730780313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLODOVEO R. GOSUICO III Administrator 909-884-3044 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2020-11-02 |