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13001 Ramona Blvd Suite H & Suite I Irwindale CA 91706-3752 | |
| (626) 337-3828 | |
| (626) 960-4163 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 13001 Ramona Blvd, Irwindale, California |
| Authorized Official Name and Position | James J. Balla (PRESIDENT & CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6262545000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
800 S Santa Anita Ave Arcadia CA 91006-6853 Ph: (626) 254-5000 | 13001 Ramona Blvd Suite H & Suite I Irwindale CA 91706-3752 Ph: (626) 337-3828 |
| NPI Number | 1568648434 |
|---|---|
| Provider Enumeration Date | 01/10/2008 |
| Last Update Date | 09/23/2021 |
| Certification Date | 09/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568648434 | NPI | - | NPPES |
| 19AN | Medicaid | CA | |
| 7748 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Renew Integrated Program #2 Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5200 Irwindale Ave Ste 210, Irwindale, CA 91706 Phone: 626-960-3964 | |