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General NPI Number Information
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NPI Number | 1922684588
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW TRANSITIONAL LLC
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 3623 SHANDIN DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-5837
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Country | US
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Telephone | 213-709-5096
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Fax |
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Provider Business Mailing Address
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Address Line | 3623 SHANDIN DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-5837
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Country | US
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Telephone | 213-709-5096
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Fax |
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Authorized Official
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Title or Position | CEO / OWNER
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Name | MR. WAYNE A. JOHNSON SR.
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Credential | MASTER OF SCIENCE
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Telephone | 213-709-5096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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