| Five Acres Strtp Colby | |
|
704 W. Mountain View St. Altadena CA 91001-4925 | |
| (626) 798-6793 | |
| Not Available |
| Full Name | Five Acres Strtp Colby |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 704 W. Mountain View St., Altadena, California |
| Authorized Official Name and Position | Shaulon Shanklin (DIRECTOR OF CLAIMS OPERATION) |
| Authorized Official Contact | 6269933134 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Five Acres Strtp Colby 760 W. Mountain View St Altadena CA 91001-4925 Ph: (626) 798-6793 | Five Acres Strtp Colby 704 W. Mountain View St. Altadena CA 91001-4925 Ph: (626) 798-6793 |
| NPI Number | 1790451300 |
|---|---|
| Provider Enumeration Date | 08/23/2021 |
| Last Update Date | 09/13/2021 |
| Certification Date | 09/13/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790451300 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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