Organization
CVRRC, MHS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RON STARK RRW, SAC (SAC COUNSELOR)
(909) 433-9824
Entity
Organization
Contact information
Practice address
1076 SANTO ANTONIO DR, COLTON, CA 92324-8103
(909) 433-9824
Mailing address
1076 SANTO ANTONIO DR, COLTON, CA 92324-8103
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
632008
CAADE
CA
Enumeration date
07/03/2008
Last updated
07/03/2008
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