| NPI | 1962631077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA A. OMA GRAY Chief Administrator 951-849-9491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 330016BN) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 330016AN) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2009-07-09 |