ETTIE LEE HOMES, INC (NPI# 1275167066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275167066 |
| Entity Type | Organization |
| Organization Name | ETTIE LEE HOMES, INC |
| Practice Address |
7637 Citrus Ave Fontana CA 92336-1911 |
| Mailing Address |
160 E Holt Ave Ste B Pomona CA 91767-5407 |
| Practice Telephone | 9098235662 |
| Practice Fax Number | 9093556678 |
| Mailing Telephone | 9096202521 |
| Mailing Fax Number | 9096209793 |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2020-03-02 |
| Authorized Official Name | KELLIE MARIE JARVIE (DIRECTOR OF RESIDENTIAL TREATMENT) |
| Authorized Official Telephone | 6263835334 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Ettie Lee Youth and Family Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356975148 | Ettie Lee Homes, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 11282 Spruce Ave, Bloomington, CA 92316-3228 | 2020-03-02 |
| 1174157960 | Ettie Lee Homes, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 28721 Live Oak Canyon Rd, Redlands, CA 92373-7913 | 2020-03-02 |
| 1992890057 | Ettie Lee Homes, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 160 E Holt Ave Ste B, Pomona, CA 91767-5407 | 2006-10-04 |
| 1245458546 | Ettie Lee Homes, Inc | Clinic/Center | 754 E Arrow Hwy, Suite F, Covina, CA 91722-2107 | 2007-04-23 |
| Street Address |
7637 CITRUS AVE |
| City | FONTANA |
| State | CA |
| Zip Code | 92336-1911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700361243 | Schmidt and Jefferson Dental Corporation | Dentist | 16944 South Highland Avenue, Ste. 400, Fontana, CA 92336 | 2018-10-01 |
| 1275032658 | Kenitha Pulliam | Behavioral Analyst | 14051 Catalina Ct, Fontana, CA 92336 | 2018-02-12 |
| 1568961183 | Jordan Frailey | Marriage & Family Therapist | 9161 Sierra Ave. Suite 213, Fontana, CA 92336 | 2018-02-09 |
| 1689198905 | Sara Alyssa Lynch | Specialist/Technologist | 7151 Oak Tree Place, Fontana, CA 92336 | 2017-07-28 |
| 1043749526 | Eric Ceasar Parian Lopez | Registered Nurse | 16001 Pfc Paris Montanez Dr., Fontana, CA 92336 | 2017-06-08 |
| 1275065393 | Alyssa Calderon | Marriage & Family Therapist | 14335 Quail Ct, Fontana, CA 92336 | 2017-03-29 |
| 1588029219 | Daisy Maritza Santana | Behavioral Analyst | 16320 Rosa Linda Ln, Fontana, CA 92336 | 2015-12-23 |
| 1407237498 | Natalie Kathleen Herrera | Physician Assistant | 16456 Sierra Lakes Pkwy, Suite 300, Fontana, CA 92336 | 2015-06-15 |
| 1255738241 | Southern California Picc Providers, Inc. | Spec/Tech, Cardiovascular | 5787 Little Shay Dr, Fontana, CA 92336 | 2014-11-19 |
| 1396175758 | Martha C Ajca | Physician Assistant | 17051 Sierra Lakes Parkway, Suite 101, Fontana, CA 92336 | 2013-11-22 |
| Find all providers in zip 92336 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820499 | Catholic Charities of The Diocese of Oakland | Residential Treatment Facility, Emotionally Disturbed Children | 3700 Dorisa Ave, Oakland, CA 94605-4941 | 2020-10-27 |
| 1922607944 | Inspire A Youth, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 7556 Avenida Baja, Riverside, CA 92509-3449 | 2020-10-21 |
| 1235736554 | Yvonne Dionne Robinson | Residential Treatment Facility, Emotionally Disturbed Children | 1223 E Helmick St, Carson, CA 90746-3163 | 2020-10-09 |
| 1740897784 | Paradise Adolescent Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 602 Woodlark Dr, Suisun City, CA 94585-2244 | 2020-09-24 |
| 1548877657 | T & T House of Champions | Residential Treatment Facility, Emotionally Disturbed Children | 2115 High St, Oakland, CA 94601-4335 | 2020-09-23 |
| 1902412182 | Paradise Adolescent Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 136 Valdivia Cir, San Ramon, CA 94583-2228 | 2020-09-22 |
| 1073128492 | Samuel Campbell Jr. | Residential Treatment Facility, Emotionally Disturbed Children | 4200 Crescent Rock Ln, Bakersfield, CA 93311-2860 | 2020-09-11 |
| 1336753433 | Aaron's Boys Home | Residential Treatment Facility, Emotionally Disturbed Children | 5805 Capistrano Ave Ste E, Atascadero, CA 93422-7218 | 2020-09-04 |
| 1699389452 | Millie's Youth Services, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 2512 Havenscourt Blvd, Oakland, CA 94605-1935 | 2020-08-31 |
| 1538779871 | Hidden Treasures Foundation, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1240 W 13th Ave, Escondido, CA 92025-5560 | 2020-08-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.