Provider Demographics
NPI:1467778050
Name:ASANTE FAMILY AGENCY
Entity Type:Organization
Organization Name:ASANTE FAMILY AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:UKIRU
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, MSW
Authorized Official - Phone:909-383-3322
Mailing Address - Street 1:1255 E HIGHLAND AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4652
Mailing Address - Country:US
Mailing Address - Phone:909-383-3332
Mailing Address - Fax:
Practice Address - Street 1:1255 E HIGHLAND AVE STE 107
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4652
Practice Address - Country:US
Practice Address - Phone:909-383-3332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No305S00000XManaged Care OrganizationsPoint of Service