NPI 1003046566

Shady Glen Facility

Organisation Developmental Disabilities Clinic/Center San Bernardino, CA

Practice location

Address: 2571 Shady Glen Ln, San Bernardino, CA 92408-4174
Phone: (909) 783-8806

Authorised official

Name: Patricia Stone
Title: Administrator
Phone: (909) 910-9604

Registered specialties

Developmental Disabilities Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QD1600X Licence 360911227 (CA)

Other Clinic/Center providers in California →

Registry record

NPI: 1003046566
Entity type: Organization
NPI issued: 19 Jul 2009
Record last updated: 29 Jul 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.