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General NPI Number Information
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NPI Number | 1699976597
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Entity Type | Organization
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Legal Business Name | CHILDREN'S CRISIS RESPONSE TEAM MORONGO BASIN
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 56357 PIMA TRAIL
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City | YUCCA VALLEY
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State | CA
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Zip | 92284
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Country | US
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Telephone | 909-382-3080
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Fax | 909-382-3105
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Provider Business Mailing Address
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Address Line | 268 W. HOSPITALITY LANE SUITE 400
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-0026
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Country | US
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Telephone | 909-382-3080
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Fax | 909-382-3105
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Authorized Official
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Title or Position | INFORMATION TECHNOLOGY MANAGER
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Name | MR. MICHAEL J DAY
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Credential |
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Telephone | 909-388-0570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | ZZZ74743Z
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License Number State | CA
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