Organization
K & J 1602 MANAGMENT INCORPORATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALERIA AL KHAWAJA (CEO)
(909) 217-6817
Entity
Organization
Contact information
Practice address
1602 REGENE ST, POMONA, CA 91766-5316
(909) 217-6817
Mailing address
1602 REGENE ST, POMONA, CA 91766-5316
(909) 217-6817
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
06/26/2017
Last updated
12/18/2023
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