Provider Demographics
NPI:1295863686
Name:MONTE VISTA CHILD CARE CENTER INC
Entity Type:Organization
Organization Name:MONTE VISTA CHILD CARE CENTER INC
Other - Org Name:GENOA DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-624-2774
Mailing Address - Street 1:9140 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1723
Mailing Address - Country:US
Mailing Address - Phone:909-624-2774
Mailing Address - Fax:909-624-6014
Practice Address - Street 1:130 GENOA WAY
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6151
Practice Address - Country:US
Practice Address - Phone:909-624-2774
Practice Address - Fax:909-624-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80305FMedicaid