{
"Npi": {
"NPI": "1912159385",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MONTE VISTA CHILD CARE CENTER",
"ParentOrgTIN": null,
"OrgName": "REALITOS DIVISON",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "13342 VICTORIA ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RANCHO CUCAMONGA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91739-2020",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-899-5046",
"MailingAddressFaxNumber": "909-463-2005",
"FirstLinePracticeLocationAddress": "612 REALITOS DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LA VERNE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91750-2844",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-899-5046",
"PracticeLocationAddressFaxNumber": "909-463-2005",
"EnumerationDate": "10/16/2008",
"LastUpdateDate": "06/18/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MENDOZA",
"AuthorizedOfficialFirstName": "DEISY",
"AuthorizedOfficialMiddleName": "ODETT",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MISS",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "909-912-9314",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": "960000953",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}