Provider Demographics
NPI:1710403407
Name:P.H.I.L.O.S.ADOLESCENT TREATMENT CENTERS, INC.
Entity Type:Organization
Organization Name:P.H.I.L.O.S.ADOLESCENT TREATMENT CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:909-777-3599
Mailing Address - Street 1:P.O. BOX 821
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376
Mailing Address - Country:US
Mailing Address - Phone:909-777-3599
Mailing Address - Fax:909-777-0011
Practice Address - Street 1:898 VIA LATA
Practice Address - Street 2:SUITE E
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-777-3599
Practice Address - Fax:909-777-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health