Basic Information
| Provider Information | |||||||||
| NPI: | 1255854956 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ESSEX SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1971 ESSEX CT STE 2 | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923738061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004744848 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1971 ESSEX CT STE 2 | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923738008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093073973 | ||||||||
| FaxNumber: | 9097486424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2017 | ||||||||
| LastUpdateDate: | 11/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | LONGNECKER-HARPER | ||||||||
| AuthorizedOfficialFirstName: | JAYNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8004744848 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 360099BP | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.