| NPI | 1831624493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHA AMICK Director Of Billing 909-382-7180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: CA CMM70708F) |
| 261QD0000X Clinic/Center, Dental (Licence: CA G91341) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CA CMM70708F) | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2022-09-01 |