Organization
VETERANS ALCOHOL REHABILITATION PROGRAM
Active
Other names
Gibson House for Men
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHELLY MATTAZARO (EXECUTIVE DIRECTOR)
(909) 381-3774
Entity
Organization
Contact information
Practice address
1100 N D ST, SAN BERNARDINO, CA 92410-3524
(909) 381-3774
(909) 381-6845
Mailing address
1100 N D ST, SAN BERNARDINO, CA 92410-3524
(909) 381-3774
(909) 381-6845
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
360004BN
CA
Other
Enumeration date
06/04/2007
Last updated
10/12/2023
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