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General NPI Number Information
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NPI Number | 1689210775
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Entity Type | Organization
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Legal Business Name | INLAND EMPIRE COMMUNITY OUTREACH CENTER
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Dates
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Enumeration Date | 11/23/2019
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Last Update Date | 12/25/2023
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Provider Practice Location Address
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Address Line | 473 EAST CARNEGIE DRIVE SUITE 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-269-9403
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Fax |
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Provider Business Mailing Address
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Address Line | 473 EAST CARNEGIE DRIVE SUITE 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408
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Country | US
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Telephone | 909-269-9403
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. VELVETH MELISSA LOVE
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Credential | B.S. BIOLOGY
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Telephone | 909-269-9403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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