Provider Demographics
NPI:1780956581
Name:MERITO HOUSE RESIDENTIAL TREATMENT PROGRAM
Entity type:Organization
Organization Name:MERITO HOUSE RESIDENTIAL TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-886-6678
Mailing Address - Street 1:5789 MERITO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-7215
Mailing Address - Country:US
Mailing Address - Phone:909-886-6678
Mailing Address - Fax:909-881-3434
Practice Address - Street 1:5789 MERITO AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-7215
Practice Address - Country:US
Practice Address - Phone:909-886-6678
Practice Address - Fax:909-881-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360079AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility