Healthcare Provider Details

I. General information

NPI: 1659519072
Provider Name (Legal Business Name): COMMUNITY ACCESS NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 GREEN RIVER RD STE 101
CORONA CA
92882-7452
US

IV. Provider business mailing address

2791 GREEN RIVER RD STE 101
CORONA CA
92882-7452
US

V. Phone/Fax

Practice location:
  • Phone: 951-279-3222
  • Fax: 951-279-5222
Mailing address:
  • Phone: 951-279-3222
  • Fax: 951-279-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RAFIK PHILOBOS
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 951-279-3222