Healthcare Provider Details

I. General information

NPI: 1184147761
Provider Name (Legal Business Name): CALIFORNIA FAMILY LIFE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 10/04/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N STATE ST
HEMET CA
92543-1473
US

IV. Provider business mailing address

PO BOX 727
HEMET CA
92546-0727
US

V. Phone/Fax

Practice location:
  • Phone: 951-765-6955
  • Fax: 951-765-6966
Mailing address:
  • Phone: 951-765-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY SNOW
Title or Position: HR MANAGER
Credential:
Phone: 951-765-6955