Provider Demographics
NPI:1184384216
Name:ARK HOMES FOSTER FAMILY AGENCY
Entity type:Organization
Organization Name:ARK HOMES FOSTER FAMILY AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:909-948-5747
Mailing Address - Street 1:9645 ARROW RTE.
Mailing Address - Street 2:BLDG. 5, STE. A
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4554
Mailing Address - Country:US
Mailing Address - Phone:909-948-5747
Mailing Address - Fax:909-948-5746
Practice Address - Street 1:9631 BUSINESS CENTER DR.
Practice Address - Street 2:BLDG. 14, STE. D
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4545
Practice Address - Country:US
Practice Address - Phone:909-948-5747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)