Provider Demographics
NPI:1861859464
Name:VETERANS ALCOHOL REHABILITATION PROGRAM, INC.- VARP, INC.
Entity Type:Organization
Organization Name:VETERANS ALCOHOL REHABILITATION PROGRAM, INC.- VARP, INC.
Other - Org Name:VARP, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTAZARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-381-3774
Mailing Address - Street 1:1100 N. 'D' ST.
Mailing Address - Street 2:
Mailing Address - City:SAN BERNADINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3524
Mailing Address - Country:US
Mailing Address - Phone:909-381-3774
Mailing Address - Fax:909-381-6845
Practice Address - Street 1:1103 N. 'D' ST.
Practice Address - Street 2:
Practice Address - City:SAN BERNADINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3524
Practice Address - Country:US
Practice Address - Phone:909-381-3774
Practice Address - Fax:909-381-6845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VETERANS ALCOHOL REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-27
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360004FN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility