Provider Demographics
NPI:1962699751
Name:MERRILL COMMUNITY SERV INC
Entity type:Organization
Organization Name:MERRILL COMMUNITY SERV INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:DEAVON
Authorized Official - Last Name:BATISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-823-0609
Mailing Address - Street 1:9161 SIERRA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-4729
Mailing Address - Country:US
Mailing Address - Phone:909-823-0609
Mailing Address - Fax:909-823-4187
Practice Address - Street 1:9161 SIERRA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4729
Practice Address - Country:US
Practice Address - Phone:909-823-0609
Practice Address - Fax:909-823-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360016AN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
363648OtherMED I CAL