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1350 3rd St La Verne CA 91750-5201 | |
| (909) 596-5921 | |
| (909) 596-3954 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1350 3rd St, La Verne, California |
| Authorized Official Name and Position | Charles Rich (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9095965921 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1350 3rd St La Verne CA 91750-5201 Ph: (909) 596-5921 | 1350 3rd St La Verne CA 91750-5201 Ph: (909) 596-5921 |
| NPI Number | 1407917784 |
|---|---|
| Provider Enumeration Date | 12/12/2006 |
| Last Update Date | 08/18/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407917784 | NPI | - | NPPES |
| 01227 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 7566A (California) | Primary |
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