Provider Demographics
NPI:1699191866
Name:CONCERNED CITIZENS FOR THE DEVELOPMENT OF THE NORTH FONTANA
Entity Type:Organization
Organization Name:CONCERNED CITIZENS FOR THE DEVELOPMENT OF THE NORTH FONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-333-9950
Mailing Address - Street 1:16666 BASELINE AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-2043
Mailing Address - Country:US
Mailing Address - Phone:909-333-9950
Mailing Address - Fax:909-440-5659
Practice Address - Street 1:16666 BASELINE AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-2043
Practice Address - Country:US
Practice Address - Phone:909-333-9950
Practice Address - Fax:909-440-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care