Organization
PRIMARY RELIANCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CELESTINE GREEN (OWNER)
(626) 966-1373
Entity
Organization
Contact information
Practice address
2145 VICTORIA WAY, POMONA, CA 91767-2362
(626) 622-1153
Mailing address
226 N STEPHORA AVE, COVINA, CA 91724-3152
(626) 966-1373
(626) 915-1155
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LTC61037F
VICTORIA WAY PROVIDER NO.
CA
Enumeration date
03/19/2007
Last updated
08/22/2020
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