Provider Demographics
NPI:1851522098
Name:AKLAN MEADOWS, INC
Entity Type:Organization
Organization Name:AKLAN MEADOWS, INC
Other - Org Name:AMI-HOLLY HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:VERGEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-229-7563
Mailing Address - Street 1:15340 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-5387
Mailing Address - Country:US
Mailing Address - Phone:909-574-2577
Mailing Address - Fax:909-822-2405
Practice Address - Street 1:15340 HOLLY DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5387
Practice Address - Country:US
Practice Address - Phone:909-574-2577
Practice Address - Fax:909-822-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366409901320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities