Provider Demographics
NPI:1427670694
Name:SEALEY, INC.
Entity type:Organization
Organization Name:SEALEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALBE
Authorized Official - Middle Name:
Authorized Official - Last Name:EALEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:909-731-3955
Mailing Address - Street 1:7089 FONTAINE PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1671
Mailing Address - Country:US
Mailing Address - Phone:909-731-3955
Mailing Address - Fax:
Practice Address - Street 1:10808 FOOTHILL BLVD STE 160-725
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3889
Practice Address - Country:US
Practice Address - Phone:909-731-3955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)