Provider Demographics
NPI:1528641511
Name:EAST VALLEY CHARLEE, INC.
Entity type:Organization
Organization Name:EAST VALLEY CHARLEE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FACILITATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-307-5777
Mailing Address - Street 1:440 CAJON ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5955
Mailing Address - Country:US
Mailing Address - Phone:909-307-5777
Mailing Address - Fax:909-307-5776
Practice Address - Street 1:35895 SANTA MARIA ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-5504
Practice Address - Country:US
Practice Address - Phone:909-307-5777
Practice Address - Fax:909-307-5776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST VALLEY CHARLEE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-28
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children