Healthcare Provider Details

I. General information

NPI: 1184134033
Provider Name (Legal Business Name): GARCES RESIDENTIAL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2243 N MOUNTAIN AVE
CLAREMONT CA
91711-1586
US

IV. Provider business mailing address

7349 MILLIKEN AVE SUITE 140-223
RANCHO CUCAMONGA CA
91730-7435
US

V. Phone/Fax

Practice location:
  • Phone: 909-447-5346
  • Fax: 909-624-3810
Mailing address:
  • Phone: 909-646-9509
  • Fax: 909-646-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. CARLOS ALBERTO GARCES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 909-376-6619