Provider Demographics
NPI:1538352661
Name:HEMAN G. STARK YOUTH CORRECTIONAL FACILITY
Entity type:Organization
Organization Name:HEMAN G. STARK YOUTH CORRECTIONAL FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST II
Authorized Official - Prefix:MR
Authorized Official - First Name:GIAO
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:909-606-5000
Mailing Address - Street 1:15180 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-9148
Mailing Address - Country:US
Mailing Address - Phone:909-606-5000
Mailing Address - Fax:909-606-5075
Practice Address - Street 1:15180 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-9148
Practice Address - Country:US
Practice Address - Phone:909-606-5000
Practice Address - Fax:909-606-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHPE 36930273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit