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General NPI Number Information
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NPI Number | 1841443918
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Entity Type | Organization
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Legal Business Name | CAMP GLEN ROCKEY
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Dates
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Enumeration Date | 11/02/2008
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Last Update Date | 11/02/2008
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Provider Practice Location Address
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Address Line | 1900 SYCAMORE CANYON RD
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City | SAN DIMAS
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State | CA
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Zip | 91773-1220
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Country | US
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Telephone | 909-599-2391
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Fax |
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Provider Business Mailing Address
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Address Line | 550 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90020-1912
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | GINA SCANLON
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Credential |
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Telephone | 909-599-2391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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