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General NPI Number Information
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NPI Number | 1942406780
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Entity Type | Organization
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Legal Business Name | PROTOTYPES WOMENS CENTER OUTPATIENT
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6339 MANUEL CT
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City | CHINO
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State | CA
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Zip | 91710-4628
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Country | US
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Telephone | 909-591-7251
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Fax |
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Provider Business Mailing Address
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Address Line | 6339 MANUEL CT
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City | CHINO
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State | CA
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Zip | 91710-4628
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Country | US
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Telephone | 909-591-7251
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Fax |
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Authorized Official
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Title or Position | COUNSELORCASEMANAGER
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Name | MS. KIM A FRANKLIN
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Credential |
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Telephone | 909-591-7251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | CA
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