Healthcare Provider Details

I. General information

NPI: 1306779020
Provider Name (Legal Business Name): HARVEST COMMUNITY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 BEAUMONT AVE
BEAUMONT CA
92223-1505
US

IV. Provider business mailing address

1225 BEAUMONT AVE
BEAUMONT CA
92223-1505
US

V. Phone/Fax

Practice location:
  • Phone: 619-586-0278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DOMINIC BULLOCK
Title or Position: LEAD CARE MANAGER
Credential:
Phone: 619-586-0278