Provider Demographics
NPI:1144550971
Name:MY BROTHER'S KEEPER
Entity type:Organization
Organization Name:MY BROTHER'S KEEPER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/ DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-464-0400
Mailing Address - Street 1:5511 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4302
Mailing Address - Country:US
Mailing Address - Phone:909-464-0400
Mailing Address - Fax:909-464-0433
Practice Address - Street 1:5511 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4302
Practice Address - Country:US
Practice Address - Phone:909-464-0400
Practice Address - Fax:909-464-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty