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General NPI Number Information
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NPI Number | 1407248297
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Entity Type | Organization
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Legal Business Name | KNOTTS FAMILY AGENCY
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 1505 W HIGHLAND AVE STE 17
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1253
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Country | US
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Telephone | 909-880-0600
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Fax | 909-473-1918
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Provider Business Mailing Address
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Address Line | 1505 W HIGHLAND AVE STE 17
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1253
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Country | US
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Telephone | 909-880-0600
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Fax | 909-473-1918
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. EDWARD MCFIELD
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Credential | PHD
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Telephone | 909-880-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 366408258
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License Number State | CA
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