| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 316 E E St, Ontario, California |
| Authorized Official Name and Position | James C. Callaghan (PRESIDENT/CEO) |
| Authorized Official Contact | 8585732600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9465 Farnham San Diego CA 92123 Ph: (858) 573-2600 | 316 E E St Ontario CA 91764-3712 Ph: (909) 983-4466 |
| NPI Number | 1982071627 |
|---|---|
| Provider Enumeration Date | 08/28/2015 |
| Last Update Date | 08/27/2020 |
| Certification Date | 08/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982071627 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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