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General NPI Number Information
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NPI Number | 1407641665
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Entity Type | Organization
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Legal Business Name | DIGNITY COMMUNITY SUPPORT SERVICES
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 13631 JEREMY CT
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-2031
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Country | US
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Telephone | 909-803-0601
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Fax |
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Provider Business Mailing Address
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Address Line | 12352 RUTHERFORD DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8871
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Country | US
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Telephone | 909-312-9480
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Fax |
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Authorized Official
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Title or Position | HEAD OF SERVICE
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Name | DR. LAQEISHIA HAGANS
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Credential | EDD
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Telephone | 909-312-9480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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