Provider Demographics
NPI:1073070686
Name:A COMING OF AGE TO ADULTHOOD, INC
Entity Type:Organization
Organization Name:A COMING OF AGE TO ADULTHOOD, INC
Other - Org Name:A COMING OF AGE FOSTER FAMILY AGENCY AND COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAMARR
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:951-488-8053
Mailing Address - Street 1:PO BOX 9640
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-9640
Mailing Address - Country:US
Mailing Address - Phone:951-776-9223
Mailing Address - Fax:951-776-9250
Practice Address - Street 1:7899 MISSION GROVE PKWY S STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5062
Practice Address - Country:US
Practice Address - Phone:951-776-9223
Practice Address - Fax:951-776-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health