Basic Information
| Provider Information | |||||||||
| NPI: | 1265838023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LSS COMMUNITY CARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 E MOUNTAIN VIEW STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92311 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 309 E MOUNTAIN VIEW ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923112814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602567279 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SPENCER | ||||||||
| AuthorizedOfficialFirstName: | BEVERLEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 7602567279 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 0 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.