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NPI Code Detail

MEDICARE: VETERANS ALCOHOL REHABILITATION PROGRAM

MEDICARE: VETERANS ALCOHOL REHABILITATION PROGRAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility360004BNCA

General Provider Information

NPI Number : 1033311881
Entity Type Code : Organization
Provider Name (Legal Business Name) : VETERANS ALCOHOL REHABILITATION PROGRAM
Provider Business Mailing Address
First Line : 1100 N D ST
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92410-3524
Country : US
Telephone Number : 909-381-3774
Fax Number : 909-381-6845
Provider Business Practice Location Address
First Line : 1100 N D ST
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92410-3524
Country : US
Telephone Number : 909-381-3774
Fax Number : 909-381-6845
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. SHELLY MATTAZARO
Credential :
Telephone Number : 909-381-3774
Provider Enumeration Date : 06/04/2007
Last Update Date : 10/12/2023

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Directions to “VETERANS ALCOHOL REHABILITATION PROGRAM ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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