Provider Demographics
NPI:1588894760
Name:REDHILL FACILITY
Entity type:Organization
Organization Name:REDHILL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRLETICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-982-7550
Mailing Address - Street 1:7628 ALTA CUESTA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7628 ALTA CUESTA DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1010
Practice Address - Country:US
Practice Address - Phone:909-982-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIDGES IN COMMUNICATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360911291261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities