Healthcare Provider Details

I. General information

NPI: 1265838023
Provider Name (Legal Business Name): LSS COMMUNITY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MOUNTAIN VIEW ST SUITE 100
BARSTOW CA
92311-2814
US

IV. Provider business mailing address

309 E MOUNTAIN VIEW STREET SUITE 100
BARSTOW CA
92311
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-7279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0
License Number StateCA

VIII. Authorized Official

Name: BEVERLEE SPENCER
Title or Position: SUPERVISOR
Credential:
Phone: 760-256-7279