Healthcare Provider Details

I. General information

NPI: 1629518147
Provider Name (Legal Business Name): MCKINLEY CHILDREN'S CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 CYPRESS ST
SAN DIMAS CA
91773-3505
US

IV. Provider business mailing address

762 CYPRESS ST
SAN DIMAS CA
91773-3505
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-1227
  • Fax: 909-592-3841
Mailing address:
  • Phone: 909-599-1227
  • Fax: 909-592-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number191502075
License Number StateCA

VIII. Authorized Official

Name: MR. ANIL VADAPARTY
Title or Position: CEO
Credential: SPHR, ESQ.
Phone: 909-599-1227