Healthcare Provider Details

I. General information

NPI: 1629987318
Provider Name (Legal Business Name): KIDS IN KONFLICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 WHIPPLE MOUNTAIN RD
SAN BERNARDINO CA
92410-2109
US

IV. Provider business mailing address

295 WHIPPLE MOUNTAIN RD
SAN BERNARDINO CA
92410-2109
US

V. Phone/Fax

Practice location:
  • Phone: 951-961-5066
  • Fax:
Mailing address:
  • Phone: 951-961-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. LONNIE GARDNER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 951-961-5066