Provider Demographics
NPI:1255068987
Name:FAITH IN ACTION OF SAN GORGONIO PASS
Entity type:Organization
Organization Name:FAITH IN ACTION OF SAN GORGONIO PASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:951-293-9603
Mailing Address - Street 1:66 S SAN GORGONIO AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-6020
Mailing Address - Country:US
Mailing Address - Phone:951-293-9603
Mailing Address - Fax:
Practice Address - Street 1:66 S SAN GORGONIO AVE STE 6
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-6020
Practice Address - Country:US
Practice Address - Phone:951-293-9603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management