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General NPI Number Information
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NPI Number | 1427592963
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Entity Type | Organization
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Legal Business Name | CARISSA GROUP INC.
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 1048 STOWELL RANCH CIR
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City | CORONA
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State | CA
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Zip | 92881-4739
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Country | US
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Telephone | 909-815-7412
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Fax | 951-278-2957
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Provider Business Mailing Address
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Address Line | 1048 STOWELL RANCH CIR
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City | CORONA
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State | CA
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Zip | 92881-4739
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Country | US
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Telephone | 909-815-7412
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Fax | 951-278-2957
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SARBJIT MANN
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Credential |
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Telephone | 909-815-7412
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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 |
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License Number State |
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