Provider Demographics
NPI:1073703898
Name:BRANDON J INC/SERENITY PLACE
Entity Type:Organization
Organization Name:BRANDON J INC/SERENITY PLACE
Other - Org Name:ACTS FOR CHILDREN
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEFEVRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-433-0330
Mailing Address - Street 1:128 E G ST STE 111
Mailing Address - Street 2:140 W. D ST
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2943
Mailing Address - Country:US
Mailing Address - Phone:909-433-0330
Mailing Address - Fax:909-433-0399
Practice Address - Street 1:128 E. G ST STE #111
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-433-0330
Practice Address - Fax:909-433-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3686073245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children