Provider Demographics
NPI:1073732897
Name:JESSIE HOPKINS HINCHEE FOUNDATION
Entity Type:Organization
Organization Name:JESSIE HOPKINS HINCHEE FOUNDATION
Other - Org Name:JESSICA HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-967-7777
Mailing Address - Street 1:825 N KELLOGG AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-1119
Mailing Address - Country:US
Mailing Address - Phone:805-685-1236
Mailing Address - Fax:805-685-2326
Practice Address - Street 1:7174 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-1352
Practice Address - Country:US
Practice Address - Phone:805-685-1236
Practice Address - Fax:805-685-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50000357320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80084FMedicaid