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656 N Park Ave Pomona CA 91768-3679 | |
| (909) 629-4084 | |
| (909) 629-4086 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 656 N Park Ave, Pomona, California |
| Authorized Official Name and Position | Cheryl Ann Ruedi (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6263315316 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
656 N Park Ave Pomona CA 91768-3679 Ph: (909) 629-4084 | 656 N Park Ave Pomona CA 91768-3679 Ph: (909) 629-4084 |
| NPI Number | 1447615539 |
|---|---|
| Provider Enumeration Date | 12/16/2015 |
| Last Update Date | 12/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447615539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 190241BN (California) | Primary |
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