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Organization

HARBOR VILLAGE DETOXIFICATION AND REHABILITATION INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. MARIA CATHERINE KOH CHUA (DIRECTOR / LICENSE MANAGER)
(909) 904-7003
Entity
Organization

Contact information

Practice address
1620 EL TRAVESIA DR, LA HABRA HEIGHTS, CA 90631-8002
(909) 904-7003
Mailing address
5787 LITTLE SHAY DR, FONTANA, CA 92336-4593
(909) 904-7003

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C4033816
CALIFORNIA SECRETARY OF STATE REGISTRATION
CA
Enumeration date
06/21/2017
Last updated
06/21/2017
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