Healthcare Provider Details

I. General information

NPI: 1083341143
Provider Name (Legal Business Name): KEYS TO TRANQUILITY- IOP AND PHP PROGRAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RAMONA AVE STE 207
CORONA CA
92879-1443
US

IV. Provider business mailing address

400 RAMONA AVE STE 207
CORONA CA
92879-1443
US

V. Phone/Fax

Practice location:
  • Phone: 888-883-7639
  • Fax:
Mailing address:
  • Phone: 888-883-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL ARNOLD
Title or Position: CEO
Credential:
Phone: 909-559-4062