Organization
CRYSTAL MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAIL HADDADIN ADULT RESIDENTAL (FACILITY)
(626) 337-1424
Entity
Organization
Contact information
Practice address
3406 BALDWIN PARK BLVD, BALDWIN PARK, CA 91706-4807
(626) 337-1424
Mailing address
3406 BALDWIN PARK BLVD, BALDWIN PARK, CA 91706-4807
(626) 337-1424
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
191501799
CA
Other
Enumeration date
06/22/2009
Last updated
06/22/2009
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