Organization
ROBERTS GROUP HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HAZEL GERTRUDE ROBERTS PERSONAL CARE PROVID (OWNER/PRESIDENT)
(909) 623-3353
Entity
Organization
Contact information
Practice address
1435 EAST GRAND AVE, POMONA, CA 91766
(909) 623-3353
(909) 623-1143
Mailing address
1435 EAST GRAND AVE, POMONA, CA 91766
(909) 623-3353
(909) 623-1143
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
191501024
CA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
191592141
CA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
360906027
CA
Other
Enumeration date
08/20/2009
Last updated
08/20/2009
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