Organization
SOUTHSIDE MANOR INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES PARDUE (PRESIDENT)
(909) 623-7305
Entity
Organization
Contact information
Practice address
820 E GRAND AVE, POMONA, CA 91766-3662
(909) 623-7305
(909) 623-7898
Mailing address
820 E GRAND AVE, POMONA, CA 91766-3662
(909) 623-7305
(909) 623-7898
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
191502984
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
320900000X
DOMICILIARY CARE FACITITIY
CA
Enumeration date
07/23/2009
Last updated
08/26/2009
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