Organization
CHANGING THEIR LIVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDA JOHNSON (CEO)
(531) 233-7715
Entity
Organization
Contact information
Practice address
25573 18TH ST, SAN BERNARDINO, CA 92404-5604
(531) 233-7715
Mailing address
25573 18TH ST, SAN BERNARDINO, CA 92404-5604
(531) 233-7715
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/03/2025
Last updated
02/03/2025
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