Organization
MERRILL COMMUNITY SERV INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WARREN DEAVON BATISTE (EXECUTIVE DIRECTOR)
(909) 823-0609
Entity
Organization
Contact information
Practice address
9161 SIERRA AVE, SUITE 200, FONTANA, CA 92335-4729
(909) 823-0609
(909) 823-4187
Mailing address
9161 SIERRA AVE, SUITE 200, FONTANA, CA 92335-4729
(909) 823-0609
(909) 823-4187
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
360016AN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
363648
MED I CAL
—
Enumeration date
09/26/2007
Last updated
03/03/2009
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