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General NPI Number Information
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NPI Number | 1386765345
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Entity Type | Organization
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Legal Business Name | LDS FAMILY SERVICES
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 791 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1800
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Country | US
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Telephone | 909-824-0480
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Fax | 909-824-0487
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Provider Business Mailing Address
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Address Line | 791 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1800
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Country | US
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Telephone | 909-824-0480
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Fax | 909-824-0487
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | MR. GLENN FARR
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Credential |
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Telephone | 909-824-0480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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