| Specialized Foster Care Glendora | |
|
725 S Grand Ave Glendora CA 91740-4141 | |
| (626) 691-1700 | |
| (626) 691-1178 |
| Full Name | Specialized Foster Care Glendora |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 725 S Grand Ave, Glendora, California |
| Authorized Official Name and Position | Lisa H. Wong (ACTING DIRECTOR) |
| Authorized Official Contact | 2137384601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialized Foster Care Glendora 510 S Vermont Ave Los Angeles CA 90020-1992 Ph: (213) 738-4601 | Specialized Foster Care Glendora 725 S Grand Ave Glendora CA 91740-4141 Ph: (626) 691-1700 |
| NPI Number | 1831338193 |
|---|---|
| Provider Enumeration Date | 02/10/2009 |
| Last Update Date | 08/08/2022 |
| Certification Date | 08/08/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831338193 | NPI | - | NPPES |
| 7753 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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