COLUMBINE DIVISION
Residential Treatment Facilities at Monte Vista Ave, Montclair, CA

License number
California 240000422
Category
Residential Treatment Facilities
Type
Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities
Owner
Name: MR. PARLUHUTAN WAHAB SIREGAR
Title: QMRP/ADMINISTRATOR
Phone: (909) 624-2774
Address
Address
9140 Monte Vista Ave, Montclair, CA 91763
National Provider ID: 1649422080
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Residential Treatment Facilities licenses in California





Other Doctors licenses in California