Provider Demographics
NPI:1073722005
Name:LANDMARK MEDICAL CENTER
Entity Type:Organization
Organization Name:LANDMARK MEDICAL CENTER
Other - Org Name:LANDMARK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:CAMPOS
Authorized Official - Last Name:KILBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-593-2585
Mailing Address - Street 1:2030 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2722
Mailing Address - Country:US
Mailing Address - Phone:909-593-2585
Mailing Address - Fax:909-593-4120
Practice Address - Street 1:2030 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2722
Practice Address - Country:US
Practice Address - Phone:909-593-2585
Practice Address - Fax:909-593-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950000062323P00000X
323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility