Organization
WEST VALLEY FAST
Active
Parent organization
DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY CA
Organization subpart
Yes
Provider details
NPI number
Legal business name
DEPARTMENT OF BEHAVIORAL HEALTH, SAN BERNARDINO COUNTY CA
Authorized official
MR. MICHAEL J DAY (BUSINESS APPLICATION MANAGER)
(909) 382-3080
Entity
Organization
Contact information
Practice address
9478 ETIWANDA AVE, RANCHO CUCAMONGA, CA 91739-9662
(909) 382-3080
(909) 382-3105
Mailing address
268 W HOSPITALITY LN, SUITE 400, SAN BERNARDINO, CA 92415-0001
(909) 382-3080
(909) 382-3105
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
ZZZ74743Z
CA
Other
Enumeration date
05/22/2007
Last updated
07/13/2007
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