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1350 3rd St La Verne CA 91750-5201 | |
| (909) 593-2581 | |
| (909) 596-3567 |
| Full Name | |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 1350 3rd St, La Verne, California |
| Authorized Official Name and Position | Daniel S. Maydeck (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9095932581 |
| 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) 593-2581 | 1350 3rd St La Verne CA 91750-5201 Ph: (909) 593-2581 |
| NPI Number | 1164548236 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 04/12/2021 |
| Certification Date | 04/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164548236 | NPI | - | NPPES |
| 7565A | Other | CA | OUTPATIENT MENTAL HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | 191501972 (California) | Primary |
Tri-city Mental Health Authority Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3102 D St, La Verne, CA 91750 Phone: 909-766-7340 | |
Tri-city Mental Health Authority Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2715 E St, La Verne, CA 91750 Phone: 909-971-8205 | |
Ideal Care & Health Services Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6601 Stephens Ranch Rd, La Verne, CA 91750 Phone: 310-806-2693 Fax: 909-865-0193 |