Provider Demographics
NPI:1306394879
Name:WEST COVINA FOSTER FAMILY AGENCY
Entity Type:Organization
Organization Name:WEST COVINA FOSTER FAMILY AGENCY
Other - Org Name:SUNRISE HORIZON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUKHWINDER
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-814-9085
Mailing Address - Street 1:527 E ROWLAND ST STE 100C&D
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3266
Mailing Address - Country:US
Mailing Address - Phone:626-814-9085
Mailing Address - Fax:626-814-2276
Practice Address - Street 1:4041 CARROLL COURT
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3139
Practice Address - Country:US
Practice Address - Phone:909-591-2589
Practice Address - Fax:909-364-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed ChildrenGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197804217Medicaid