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955 N D St San Bernardino CA 92410-3519 | |
| (909) 889-6519 | |
| (909) 889-6560 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 955 N D St, San Bernardino, California |
| Authorized Official Name and Position | Tina Hughes (CEO) |
| Authorized Official Contact | 9099321069 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
916 N Mountain Ave Suite A Upland CA 91786-3697 Ph: (909) 932-1069 | 955 N D St San Bernardino CA 92410-3519 Ph: (909) 889-6519 |
| NPI Number | 1427464429 |
|---|---|
| Provider Enumeration Date | 07/10/2014 |
| Last Update Date | 12/28/2023 |
| Certification Date | 12/28/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427464429 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 360001ABN (California) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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