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General NPI Number Information
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NPI Number | 1962699751
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Entity Type | Organization
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Legal Business Name | MERRILL COMMUNITY SERV INC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 9161 SIERRA AVE SUITE 200
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City | FONTANA
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State | CA
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Zip | 92335-4729
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Country | US
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Telephone | 909-823-0609
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Fax | 909-823-4187
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Provider Business Mailing Address
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Address Line | 9161 SIERRA AVE SUITE 200
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City | FONTANA
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State | CA
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Zip | 92335-4729
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Country | US
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Telephone | 909-823-0609
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Fax | 909-823-4187
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. WARREN DEAVON BATISTE
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Credential |
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Telephone | 909-823-0609
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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 | 360016AN
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License Number State | CA
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