Provider Demographics
NPI:1922326180
Name:INLAND EMPIRE JOB CORPS CENTER
Entity Type:Organization
Organization Name:INLAND EMPIRE JOB CORPS CENTER
Other - Org Name:MANAGEMENT AND TRAINING CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-887-7146
Mailing Address - Street 1:3173 KERRY ST
Mailing Address - Street 2:HEALTH & WELLNESS DEPARTMENT
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-6325
Mailing Address - Country:US
Mailing Address - Phone:909-887-7105
Mailing Address - Fax:909-473-1510
Practice Address - Street 1:3173 KERRY ST
Practice Address - Street 2:HEALTH & WELLNESS DEPARTMENT
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-6325
Practice Address - Country:US
Practice Address - Phone:909-887-7105
Practice Address - Fax:909-473-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53297261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health