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General NPI Number Information
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NPI Number | 1538352661
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Entity Type | Organization
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Legal Business Name | HEMAN G. STARK YOUTH CORRECTIONAL FACILITY
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 15180 EUCLID AVE
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City | CHINO
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State | CA
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Zip | 91710-9148
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Country | US
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Telephone | 909-606-5000
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Fax | 909-606-5075
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Provider Business Mailing Address
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Address Line | 15180 EUCLID AVE
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City | CHINO
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State | CA
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Zip | 91710-9148
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Country | US
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Telephone | 909-606-5000
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Fax | 909-606-5075
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Authorized Official
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Title or Position | PHARMACIST II
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Name | MR. GIAO NGOC HOANG
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Credential | PHARMACIST
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Telephone | 909-606-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | HPE 36930
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License Number State | CA
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