Provider Demographics
NPI:1962930982
Name:BOURNE INC
Entity type:Organization
Organization Name:BOURNE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TIERRA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-587-7444
Mailing Address - Street 1:2235 LAKE AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-6041
Mailing Address - Country:US
Mailing Address - Phone:626-797-9196
Mailing Address - Fax:626-345-9970
Practice Address - Street 1:1280 N HILL AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-3050
Practice Address - Country:US
Practice Address - Phone:626-797-9190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-03
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children