Provider Demographics
NPI:1326585266
Name:HARVEY HOUSE MANOR II
Entity Type:Organization
Organization Name:HARVEY HOUSE MANOR II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STBA
Authorized Official - Prefix:MS
Authorized Official - First Name:LELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORCEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-706-2650
Mailing Address - Street 1:11372 SAN JUAN ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3329
Mailing Address - Country:US
Mailing Address - Phone:877-706-2650
Mailing Address - Fax:
Practice Address - Street 1:11372 SAN JUAN ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3329
Practice Address - Country:US
Practice Address - Phone:877-706-2650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360111BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility