Provider Demographics
NPI:1467652438
Name:FONTANA TREATMENT CENTER
Entity Type:Organization
Organization Name:FONTANA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:FOOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-357-2940
Mailing Address - Street 1:9880 SIERRA AVE
Mailing Address - Street 2:SUITE E-F
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6714
Mailing Address - Country:US
Mailing Address - Phone:909-357-2940
Mailing Address - Fax:909-357-2999
Practice Address - Street 1:9880 SIERRA AVE
Practice Address - Street 2:SUITE E-F
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6714
Practice Address - Country:US
Practice Address - Phone:909-357-2940
Practice Address - Fax:909-357-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone