Healthcare Provider Details

I. General information

NPI: 1962075564
Provider Name (Legal Business Name): SUMMERPLACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 E DEODAR ST
ONTARIO CA
91764-1624
US

IV. Provider business mailing address

2027 E DEODAR ST
ONTARIO CA
91764-1624
US

V. Phone/Fax

Practice location:
  • Phone: 909-945-2736
  • Fax:
Mailing address:
  • Phone: 909-945-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUNE HAYES
Title or Position: CLINICAL DIRECTOR
Credential: PHD
Phone: 909-945-2736