Provider Demographics
NPI:1942406780
Name:PROTOTYPES WOMENS CENTER OUTPATIENT
Entity Type:Organization
Organization Name:PROTOTYPES WOMENS CENTER OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELORCASEMANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-591-7251
Mailing Address - Street 1:6339 MANUEL CT
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4628
Mailing Address - Country:US
Mailing Address - Phone:909-591-7251
Mailing Address - Fax:
Practice Address - Street 1:6339 MANUEL CT
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4628
Practice Address - Country:US
Practice Address - Phone:909-591-7251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320800000X
3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children