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General NPI Number Information
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NPI Number | 1144176595
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Entity Type | Organization
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Legal Business Name | VIA NOVA STABILIZATION & REENTRY NETWORK LLC
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 11274 FISHERMAN LN
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City | VICTORVILLE
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State | CA
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Zip | 92392-4837
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Country | US
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Telephone | 323-395-8594
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Fax |
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Provider Business Mailing Address
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Address Line | 11274 FISHERMAN LN
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City | VICTORVILLE
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State | CA
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Zip | 92392-4837
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Country | US
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Telephone | 323-395-8594
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEDRA CREER
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Credential |
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Telephone | 323-395-8594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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