Healthcare Provider Details

I. General information

NPI: 1386438893
Provider Name (Legal Business Name): CALIFORNIA IMPACT COALITION FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 INCLINE CT
ANTIOCH CA
94531-8265
US

IV. Provider business mailing address

3021 CITRUS CIR STE 110
WALNUT CREEK CA
94598-2643
US

V. Phone/Fax

Practice location:
  • Phone: 925-433-2791
  • Fax: 925-433-2758
Mailing address:
  • Phone: 925-433-2791
  • Fax: 925-433-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MANDAVE SANDHU
Title or Position: BOARD MEMBER
Credential:
Phone: 510-410-4371