Healthcare Provider Details

I. General information

NPI: 1427855832
Provider Name (Legal Business Name): CHILDREN COUNTRY & LIVES (CCL)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2579 BRIDLE PATH DR
GILROY CA
95020-9185
US

IV. Provider business mailing address

2579 BRIDLE PATH DR
GILROY CA
95020-9185
US

V. Phone/Fax

Practice location:
  • Phone: 408-621-5262
  • Fax:
Mailing address:
  • Phone: 408-621-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALMA DELIA MORENO
Title or Position: BOARD MEMBER
Credential:
Phone: 408-621-5262