| NPI | 1922476621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE TERRY Billing Manager 909-379-9237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 330154AP) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 300346AP) | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 330154AP) | |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2019-05-06 |