# DPARTMENT OF BEHAVIORAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154503969
- **Authorized official:** DR. EUGENE CARLSON (CLINIC SUPERVISOR)
- **Authorized official phone:** (909) 458-9487

## Contact information

- **Practice address:** 1637 E HOLT BLVD, ONTARIO, CA 91761-2107
- **Practice address phone:** (909) 458-9487
- **Mailing address:** 1637 E HOLT BLVD, ONTARIO, CA 91761-2107
- **Mailing address phone:** (909) 458-9487

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | OT94 | CA | Yes |

## Other

- **Enumeration date:** 12/04/2007
- **Last updated:** 12/04/2007