Provider Demographics
NPI:1588816946
Name:GROVE DIVISION
Entity type:Organization
Organization Name:GROVE DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEISY
Authorized Official - Middle Name:ODETT
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-912-9314
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:909-899-5046
Mailing Address - Fax:909-463-2005
Practice Address - Street 1:1422 GROVE AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2841
Practice Address - Country:US
Practice Address - Phone:909-899-5046
Practice Address - Fax:909-463-2005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTE VISTA CHILD CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-16
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000529320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities