Organization
HAYNES FAMILY OF PROGRAMS
Active
Other names
HAYNES FP STRTP
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA JONES (STRTP ASSISTANT DIRECTOR)
(909) 593-2581
Entity
Organization
Contact information
Practice address
233 WEST BASELINE ROAD, LA VERNE, CA 91750-2353
(909) 593-2581
(909) 833-2998
Mailing address
233 WEST BASELINE RD, BOX 400, LA VERNE, CA 91750-2353
(909) 593-2581
(909) 614-7466
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0175.00.02
FACILITY LICENSE
CA
Enumeration date
04/05/2017
Last updated
01/28/2020
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