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General NPI Number Information
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NPI Number | 1679704811
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Entity Type | Organization
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Legal Business Name | AKLAN MEADOWS, INC.
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 1619 RICHARDSON ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2985
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Country | US
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Telephone | 909-799-0340
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Fax | 909-822-2405
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Provider Business Mailing Address
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Address Line | 11506 LEATHERLEAF RD
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City | FONTANA
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State | CA
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Zip | 92337-1044
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Country | US
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Telephone | 909-229-7563
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Fax | 909-822-2405
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. VERGEL I SANTOS
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Credential |
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Telephone | 909-229-7563
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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 | 366412448
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License Number State | CA
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