Healthcare Provider Details

I. General information

NPI: 1528743846
Provider Name (Legal Business Name): MCKINLEY CHILDREN'S CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 ALLSTATE DR
RIVERSIDE CA
92501-1702
US

IV. Provider business mailing address

180 VIA VERDE STE 200
SAN DIMAS CA
91773-3993
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-1227
  • Fax:
Mailing address:
  • Phone: 909-599-1227
  • 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

VIII. Authorized Official

Name: GABRIELA RHODES
Title or Position: AVP OF CONTRACT COMPLIANCE
Credential: MPA
Phone: 909-599-1227