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General NPI Number Information
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NPI Number | 1770907495
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Entity Type | Organization
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Legal Business Name | MERITO HOUSE, LLC
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Dates
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Enumeration Date | 02/17/2014
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 911 CHURCH ST
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City | REDLANDS
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State | CA
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Zip | 92374-3549
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Country | US
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Telephone | 909-243-7321
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Fax | 909-243-7325
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Provider Business Mailing Address
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Address Line | 333 E ARROW HWY UNIT 220
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City | UPLAND
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State | CA
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Zip | 91785-7008
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Country | US
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Telephone | 909-243-7321
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Fax | 909-243-7325
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Authorized Official
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Title or Position | CEO
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Name | MR. GLENN SWANSON
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Credential | CADAC II, BS, MBA
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Telephone | 909-243-7321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 360098AP
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License Number State | CA
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