Provider Demographics
NPI:1780434829
Name:ERICA B INDEPENDENT LIVING FACILITY
Entity type:Organization
Organization Name:ERICA B INDEPENDENT LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:GRAHAM-BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-226-1750
Mailing Address - Street 1:3656 GINGER ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7825
Mailing Address - Country:US
Mailing Address - Phone:951-226-1750
Mailing Address - Fax:951-200-4761
Practice Address - Street 1:3656 GINGER ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7825
Practice Address - Country:US
Practice Address - Phone:951-226-1750
Practice Address - Fax:951-200-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities