Basic Information
| Provider Information | |||||||||
| NPI: | 1669800678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INLAND VALLEY DRUG AND ALCOHOL RECOVERY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1260 E ARROW HWY | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099321069 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1260 E ARROW HWY | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099321069 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2013 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | HUGHES | ||||||||
| AuthorizedOfficialFirstName: | TINA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9099321069 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | BS, LAADC-CA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.