Provider Demographics
NPI:1962073965
Name:EAST VALLEY CHARLEE INC
Entity type:Organization
Organization Name:EAST VALLEY CHARLEE INC
Other - Org Name:
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:
Mailing Address - Fax:
Practice Address - Street 1:12820 GRANT ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4950
Practice Address - Country:US
Practice Address - Phone:909-797-3153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST VALLEY CHARLEE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-09
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children