Provider Demographics
NPI:1801030945
Name:C.H.A.R.L.E.E. FAMILY CARE, INC.
Entity Type:Organization
Organization Name:C.H.A.R.L.E.E. FAMILY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLLIE
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-352-3943
Mailing Address - Street 1:136 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2146
Mailing Address - Country:US
Mailing Address - Phone:951-845-3588
Mailing Address - Fax:951-845-3544
Practice Address - Street 1:136 E 6TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2146
Practice Address - Country:US
Practice Address - Phone:951-845-3588
Practice Address - Fax:951-845-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable