Healthcare Provider Details

I. General information

NPI: 1427774736
Provider Name (Legal Business Name): SALVATION NEIGHBORHOOD DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

692 E PHILLIPS BLVD
POMONA CA
91766-4549
US

IV. Provider business mailing address

692 E PHILLIPS BLVD
POMONA CA
91766-4549
US

V. Phone/Fax

Practice location:
  • Phone: 224-558-9705
  • Fax:
Mailing address:
  • Phone: 224-558-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDO O SILVA JR.
Title or Position: PRESIDENT
Credential:
Phone: 224-558-9705