Basic Information
| Provider Information | |||||||||
| NPI: | 1548531064 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POMONA ALCOHOL & DRUG RECOVERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 558 N TOWNE AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917674826 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 558 N TOWNE AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917674826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096222273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2012 | ||||||||
| LastUpdateDate: | 01/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | EJINDU | ||||||||
| AuthorizedOfficialFirstName: | TIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9096222273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.