Organization
ESSEX BOARD AND CARE FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALFONSO A LOTA (ADMINISTRATOR)
(909) 591-0791
Entity
Organization
Contact information
Practice address
11220 ESSEX AVE, POMONA, CA 91766-4048
(909) 591-0791
Mailing address
11220 ESSEX AVE, POMONA, CA 91766-4048
(909) 591-0791
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
360911118
CA
Other
Enumeration date
07/17/2009
Last updated
07/17/2009
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