NPI 1528298502

Southside Manor INC.

Organisation Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Pomona, CA

Practice location

Address: 820 E Grand Ave, Pomona, CA 91766-3662
Phone: (909) 623-7305
Fax: (909) 623-7898

Authorised official

Name: James Pardue
Title: President
Phone: (909) 623-7305

Registered specialties

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X Licence 191502984 (CA)

Other Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in California →

Registry record

NPI: 1528298502
Entity type: Organization
NPI issued: 23 Jul 2009
Record last updated: 26 Aug 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.