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General NPI Number Information
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NPI Number | 1073744660
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Entity Type | Organization
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Legal Business Name | INLAND VALLEY DRUG AND ALCOHOL RECOVERY SERVICES
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Dates
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Enumeration Date | 07/31/2009
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 939 N D ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-3519
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Country | US
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Telephone | 909-889-6519
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Fax | 909-889-6560
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Provider Business Mailing Address
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Address Line | 1260 E ARROW HWY
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City | UPLAND
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State | CA
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Zip | 91786-4982
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Country | US
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Telephone | 909-932-1069
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Fax | 909-932-1087
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | TINA K HUGHES
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Credential | BS, LAADC-CA
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Telephone | 909-932-1069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 36001AAN
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 360001ABN
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License Number State | CA
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