Provider Demographics
NPI:1942751268
Name:CAREPROVIDER ORG FOUNDATION
Entity Type:Organization
Organization Name:CAREPROVIDER ORG FOUNDATION
Other - Org Name:CCFS III POMONA
Other - Org Type:Other Name
Authorized Official - Title/Position:HEAD OF SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHEA
Authorized Official - Middle Name:ELNORA
Authorized Official - Last Name:BUFORD-LEVELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-944-2314
Mailing Address - Street 1:281 E WORKMAN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3566
Mailing Address - Country:US
Mailing Address - Phone:626-967-1105
Mailing Address - Fax:626-967-1107
Practice Address - Street 1:1593 DENSMORE ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-4333
Practice Address - Country:US
Practice Address - Phone:626-967-1105
Practice Address - Fax:626-967-1107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAREPROVIDER ORG FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-21
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children