Provider Demographics
NPI:1801192844
Name:POMONA ALCOHOL & DRUG RECOVERY CENTER
Entity Type:Organization
Organization Name:POMONA ALCOHOL & DRUG RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EJNIDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-622-2273
Mailing Address - Street 1:PO BOX 3936
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0987
Mailing Address - Country:US
Mailing Address - Phone:909-622-2273
Mailing Address - Fax:909-622-6334
Practice Address - Street 1:1540 W 2ND ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1203
Practice Address - Country:US
Practice Address - Phone:909-622-2273
Practice Address - Fax:909-622-6334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POMONA ALCOHOL & DRUG RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health