Provider Demographics
NPI:1992837538
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:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-0607
Mailing Address - Country:US
Mailing Address - Phone:909-795-5788
Mailing Address - Fax:909-795-9243
Practice Address - Street 1:82704 MILES AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4230
Practice Address - Country:US
Practice Address - Phone:760-342-5727
Practice Address - Fax:760-342-5674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLEE FAMILY CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable