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General NPI Number Information
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NPI Number | 1336371061
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Entity Type | Organization
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Legal Business Name | PRIOR BOARD & CARE
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 6121 JUPITER DR.
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City | MIRA LOMA
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State | CA
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Zip | 91752
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Country | US
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Telephone | 951-685-4912
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Fax | 951-685-4912
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Provider Business Mailing Address
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Address Line | 6121 JUPITER
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City | MIRA LOMA
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State | CA
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Zip | 91752
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Country | US
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Telephone | 951-685-4912
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Fax | 951-685-4912
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Authorized Official
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Title or Position | OWNER & LICENESSE
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Name | MAE LOIS PRIOR
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Credential |
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Telephone | 951-205-5336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 330908249
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License Number State | CA
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