Provider Demographics
NPI:1679021679
Name:JILOA TREATMENT AND RECOVERY CENTERS INC
Entity type:Organization
Organization Name:JILOA TREATMENT AND RECOVERY CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:951-203-4474
Mailing Address - Street 1:26340 KALMIA AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-1720
Mailing Address - Country:US
Mailing Address - Phone:951-203-4474
Mailing Address - Fax:951-208-4491
Practice Address - Street 1:26340 KALMIA AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-1720
Practice Address - Country:US
Practice Address - Phone:951-203-4474
Practice Address - Fax:951-208-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness