=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588544464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AQUILINE BEHAVIORAL THERAPY CENTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2025
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 W HOSPITALITY LN STE 110
-----------------------------------------------------
City | SAN BERNARDINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92408-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-907-6820
-----------------------------------------------------
Fax | 909-453-0027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 52258
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92517-3258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-907-6820
-----------------------------------------------------
Fax | 909-453-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | AKILA CRANE
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 951-907-6820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------