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1323 W Colton Ave Suite 100 Redlands CA 92374-4554 | |
| (909) 335-7067 | |
| (909) 792-2045 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1323 W Colton Ave, Redlands, California |
| Authorized Official Name and Position | Sonia Jenny Borja (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 9093357067 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 7369 Redlands CA 92375-0369 Ph: (909) 335-7067 | 1323 W Colton Ave Suite 100 Redlands CA 92374-4554 Ph: (909) 335-7067 |
| NPI Number | 1255466306 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255466306 | NPI | - | NPPES |
| 3617 | Medicaid | CA | |
| 3605 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 360023BN (California) | Primary |
| 251S00000X | Community/behavioral Health | (California) | Primary |
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