Healthcare Provider Details

I. General information

NPI: 1235086042
Provider Name (Legal Business Name): MISSION SAMOA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WESTERN ST STE B
FAIRFIELD CA
94533-2474
US

IV. Provider business mailing address

1200 WESTERN ST STE B
FAIRFIELD CA
94533-2474
US

V. Phone/Fax

Practice location:
  • Phone: 707-399-9209
  • Fax: 707-399-9209
Mailing address:
  • Phone: 707-399-9209
  • Fax: 707-399-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CLIFFORD LELIKONA PARKER
Title or Position: PROGRAM MANAGER
Credential: CRISIS COUNSELOR
Phone: 707-399-9209