Provider Demographics
NPI:1669700944
Name:FOSTER CARE AGENCY
Entity type:Organization
Organization Name:FOSTER CARE AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:ERNAN
Authorized Official - Last Name:UGBAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-693-1418
Mailing Address - Street 1:P.O BOX 25
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965
Mailing Address - Country:US
Mailing Address - Phone:530-693-1418
Mailing Address - Fax:
Practice Address - Street 1:1310 EPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-345-3952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YMOOOX320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness