Provider Demographics
NPI:1477886968
Name:ODELL YOUNG ALTERNATIVE SCHOOL
Entity Type:Organization
Organization Name:ODELL YOUNG ALTERNATIVE SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-881-2661
Mailing Address - Street 1:1455 E LYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-2728
Mailing Address - Country:US
Mailing Address - Phone:909-881-2661
Mailing Address - Fax:909-881-1661
Practice Address - Street 1:1455 E LYNWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-2728
Practice Address - Country:US
Practice Address - Phone:909-881-2661
Practice Address - Fax:909-881-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health