NPIMap

Organization Active NPI

Ettie Lee Homes, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Fontana, CA
National Provider Identifier
1275167066
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
ETTIE LEE HOMES, INC
Practice address
7637 Citrus Ave
Fontana, CA 92336-1911
Phone
(909) 823-5662
Fax
(909) 355-6678
NPI assigned
Mar 2, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Windy Luna Perez
Title
Qa Manager
Phone
(909) 620-2521

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

7637 Citrus Ave
Fontana, CA 92336-1911

Mailing address

160 E Holt Ave Ste B
Pomona, CA 91767-5407
Phone (909) 620-2521

Other names 1

  • Ettie Lee Youth and Family Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ettie Lee Homes Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729641600000",
    "number": "1275167066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 E HOLT AVE STE B",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675407",
            "telephone_number": "909-620-2521",
            "fax_number": "909-620-9793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7637 CITRUS AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923361911",
            "telephone_number": "909-823-5662",
            "fax_number": "909-355-6678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETTIE LEE HOMES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-02",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A",
        "authorized_official_last_name": "LUNA PEREZ",
        "authorized_official_first_name": "WINDY",
        "authorized_official_title_or_position": "QA MANAGER",
        "authorized_official_telephone_number": "909-620-2521"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ettie Lee Youth and Family Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ettie Lee Youth and Family Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.