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NPI Code Detail

MEDICARE: POMONA ALCOHOL & DRUG RECOVERY CENTER, INC

MEDICARE: POMONA ALCOHOL & DRUG RECOVERY CENTER, 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
1251S00000XCommunity/Behavioral Health Agency190234ANCA

General Provider Information

NPI Number : 1356485544
Entity Type Code : Organization
Provider Name (Legal Business Name) : POMONA ALCOHOL & DRUG RECOVERY CENTER, INC
Provider Business Mailing Address
First Line : 558 N TOWNE AVE
Second Line :
City : POMONA
State : CA
Zip : 91767-4826
Country : US
Telephone Number : 909-622-2273
Fax Number : 909-622-6334
Provider Business Practice Location Address
First Line : 558 N TOWNE AVE
Second Line :
City : POMONA
State : CA
Zip : 91767-4826
Country : US
Telephone Number : 909-622-2273
Fax Number : 909-622-6334
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. TIM O EJINDU
Credential :
Telephone Number : 909-622-2273
Provider Enumeration Date : 02/19/2007
Last Update Date : 08/22/2020

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