Provider Demographics
NPI:1215256300
Name:REACH OUT WEST END
Entity type:Organization
Organization Name:REACH OUT WEST END
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-982-8641
Mailing Address - Street 1:1126 W FOOTHILL BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3786
Mailing Address - Country:US
Mailing Address - Phone:909-982-8641
Mailing Address - Fax:909-982-8642
Practice Address - Street 1:1126 W FOOTHILL BLVD STE 250
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3786
Practice Address - Country:US
Practice Address - Phone:909-982-8641
Practice Address - Fax:909-982-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215256300OtherNPI