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VETERANS ALCOHOL REHABILITATION PROGRAM NPI 1033311881


NPI Information

NPI: 1033311881
Provider Name: VETERANS ALCOHOL REHABILITATION PROGRAM

Doing Business As: GIBSON HOUSE FOR MEN

Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

CLIA Number: 05D2213091

Address:
1100 N D ST
SAN BERNARDINO, CA
ZIP 92410
Phone: (909) 381-3774
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VETERANS ALCOHOL REHABILITATION PROGRAM is a substance abuse rehabilitation facility in San Bernardino, CA. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. VETERANS ALCOHOL REHABILITATION PROGRAM NPI is 1033311881. The provider is registered as an organization entity type.
The provider Is Doing Business As Gibson House For Men.

The provider's business location address is:

1100 N D ST
SAN BERNARDINO, CA
ZIP 92410-524
Phone: (909) 381-3774
Fax: (909) 381-6845

The provider's authorized official is Shelly Mattazaro .
The authorized official title is Executive Director and has the following contact phone number (909) 381-3774.

The CLIA number assigned to this NPI record is 05D2213091 - other - substance abuse ctr with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/4/2007 and was last updated on 10/12/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1324500000XSubstance Abuse Rehabilitation Facility360004BNCALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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