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General NPI Number Information
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NPI Number | 1710403407
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Entity Type | Organization
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Legal Business Name | P.H.I.L.O.S.ADOLESCENT TREATMENT CENTERS, INC.
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 898 VIA LATA SUITE E
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City | COLTON
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State | CA
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Zip | 92324
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Country | US
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Telephone | 909-777-3599
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Fax | 909-777-0011
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Provider Business Mailing Address
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Address Line | P.O. BOX 821
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City | RIALTO
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State | CA
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Zip | 92376
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Country | US
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Telephone | 909-777-3599
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Fax | 909-777-0011
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MR. THOMAS R YBARRA SR.
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Credential |
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Telephone | 909-777-3599
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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 |
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License Number State |
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