Healthcare Provider Details

I. General information

NPI: 1174014476
Provider Name (Legal Business Name): INLAND CAREGIVER RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E COOLEY DR STE 124&240
COLTON CA
92324-3934
US

IV. Provider business mailing address

1430 E COOLEY DR STE 124&240
COLTON CA
92324-3934
US

V. Phone/Fax

Practice location:
  • Phone: 909-514-1404
  • Fax: 909-514-1613
Mailing address:
  • Phone: 909-514-1404
  • Fax: 909-514-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: CARMEN ESTRADA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 909-514-1404