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NPI Code Detail

MEDICARE: BENCHMARK YOUNG ADULT SCHOOL, INC.

MEDICARE: BENCHMARK YOUNG ADULT SCHOOL, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1235553843
Entity Type Code : Organization
Provider Name (Legal Business Name) : BENCHMARK YOUNG ADULT SCHOOL, INC.
Provider Business Mailing Address
First Line : 1910 ORANGE TREE LN STE 300
Second Line :
City : REDLANDS
State : CA
Zip : 92374-4500
Country : US
Telephone Number : 909-351-4347
Fax Number : 909-793-5090
Provider Business Practice Location Address
First Line : 1906 ORANGE TREE LN STE 220
Second Line :
City : REDLANDS
State : CA
Zip : 92374-4511
Country : US
Telephone Number : 800-474-4848
Fax Number : 909-793-5090
Authorized Official
Title or Position : PARTNER
Name : DAWN TARDIFF
Credential : PHARM.D.
Telephone Number : 909-451-8334
Provider Enumeration Date : 02/18/2014
Last Update Date : 07/20/2023

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Directions to “BENCHMARK YOUNG ADULT SCHOOL, INC. ” Practice Location

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