# WANDA

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

## Provider details

- **NPI number:** 1538322656
- **Authorized official:** MS. WANDA JEAN SMITH LVN (LVN)
- **Authorized official phone:** (909) 496-2440

## Contact information

- **Practice address:** 3730 FERNWOOD AVE, RIALTO, CA 92377-2724
- **Practice address phone:** (909) 823-3703
- **Practice address fax:** (909) 823-3703
- **Mailing address:** 3730 FERNWOOD AVE, RIALTO, CA 92377-2724
- **Mailing address phone:** (909) 823-3703
- **Mailing address fax:** (909) 823-3703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 320700000X | CA | Yes |

## Other

- **Enumeration date:** 07/09/2008
- **Last updated:** 09/06/2023