Provider Demographics
NPI:1356485544
Name:POMONA ALCOHOL & DRUG RECOVERY CENTER, INC
Entity Type:Organization
Organization Name:POMONA ALCOHOL & DRUG RECOVERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:O
Authorized Official - Last Name:EJINDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-622-2273
Mailing Address - Street 1:558 N TOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-4826
Mailing Address - Country:US
Mailing Address - Phone:909-622-2273
Mailing Address - Fax:909-622-6334
Practice Address - Street 1:558 N TOWNE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-4826
Practice Address - Country:US
Practice Address - Phone:909-622-2273
Practice Address - Fax:909-622-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190234AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health