Provider Demographics
NPI:1780120436
Name:SIGMA BETA XI INC.
Entity type:Organization
Organization Name:SIGMA BETA XI INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-247-1700
Mailing Address - Street 1:14340 ELSWORTH ST
Mailing Address - Street 2:B112/113
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9019
Mailing Address - Country:US
Mailing Address - Phone:951-247-1700
Mailing Address - Fax:
Practice Address - Street 1:14340 ELSWORTH ST
Practice Address - Street 2:B112/113
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9019
Practice Address - Country:US
Practice Address - Phone:951-247-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency