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General NPI Number Information
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NPI Number | 1669529863
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Entity Type | Organization
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Legal Business Name | ALTERNATE AVENUES WOMENS RESOURCE CENTER
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 17057 FOOTHILL BLVD STE 204
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City | FONTANA
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State | CA
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Zip | 92335-3574
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Country | US
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Telephone | 909-621-4800
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Fax | 909-232-8466
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Provider Business Mailing Address
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Address Line | PO BOX 1462
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City | FONTANA
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State | CA
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Zip | 92334-1462
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Country | US
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Telephone | 909-621-4800
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Fax | 909-398-4829
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | KERRY JEPSON
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Credential |
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Telephone | 909-621-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 240000855
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License Number State | CA
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