Provider Demographics
NPI:1336371061
Name:PRIOR BOARD & CARE
Entity type:Organization
Organization Name:PRIOR BOARD & CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & LICENESSE
Authorized Official - Prefix:
Authorized Official - First Name:MAE
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:PRIOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-205-5336
Mailing Address - Street 1:6121 JUPITER
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752
Mailing Address - Country:US
Mailing Address - Phone:951-685-4912
Mailing Address - Fax:951-685-4912
Practice Address - Street 1:6121 JUPITER DR.
Practice Address - Street 2:
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752
Practice Address - Country:US
Practice Address - Phone:951-685-4912
Practice Address - Fax:951-685-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330908249320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities