Organization Name: | ANGEL OF FAITH NON PROFIT ORGANIZATION |
NPI Number: | 1003110982 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LUIS ALBERTO CRUZ (PRESIDENT/EXECUTIVE DIRECTOR) |
Mailing Address: | 4996 La Sierra Ave Riverside |
State: | CA US |
Postal Code: | 925052612 |
Phone Number: | 9515002774 |
Fax Number: | 9513580762 |
NPI Enumeration Date: | 01/06/2011 |
NPI Last Update Date: | 02/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |