Healthcare Provider Details

I. General information

NPI: 1962383687
Provider Name (Legal Business Name): SOLACE PROSPERITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12523 LIMONITE AVE # 440-120
EASTVALE CA
91752-3665
US

IV. Provider business mailing address

12523 LIMONITE AVE # 440-120
EASTVALE CA
91752-3665
US

V. Phone/Fax

Practice location:
  • Phone: 951-516-8195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ARMANI JIMMERSON
Title or Position: CEO
Credential:
Phone: 626-322-4663