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General NPI Number Information
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NPI Number | 1518317205
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Entity Type | Organization
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Legal Business Name | CHERI'S CARE
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 7231 BOULDER AVE SUITE 105
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City | HIGHLAND
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State | CA
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Zip | 92346-3313
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Country | US
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Telephone | 909-425-5372
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Fax | 909-425-9281
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Provider Business Mailing Address
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Address Line | 7231 BOULDER AVE SUITE 105
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City | HIGHLAND
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State | CA
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Zip | 92346-3313
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Country | US
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Telephone | 909-425-5372
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Fax | 909-425-9281
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. TONY CHRISTENSEN
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Credential |
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Telephone | 909-425-5372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 366427413
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 366427414
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 366427412
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License Number State | CA
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