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

License number
California 240000529
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 2
9140 Monte Vista Ave, Montclair, CA 91763
1422 Grove Ave, Upland, CA 91786
National Provider ID: 1588816946
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

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