Provider Demographics
NPI:1538514807
Name:MONTE VISTA CHILD CARE CENTER
Entity Type:Organization
Organization Name:MONTE VISTA CHILD CARE CENTER
Other - Org Name:ERIN DIVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOYENGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-899-5043
Mailing Address - Street 1:13342 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2020
Mailing Address - Country:US
Mailing Address - Phone:989-899-5043
Mailing Address - Fax:909-463-2005
Practice Address - Street 1:1303 N ERIN AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2661
Practice Address - Country:US
Practice Address - Phone:909-899-5043
Practice Address - Fax:909-463-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164558714Medicaid