Healthcare Provider Details

I. General information

NPI: 1952268351
Provider Name (Legal Business Name): FORTRESS OF REFUGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 E 1ST ST
LONG BEACH CA
90802-5907
US

IV. Provider business mailing address

1727 E 1ST ST
LONG BEACH CA
90802-5907
US

V. Phone/Fax

Practice location:
  • Phone: 310-279-8606
  • Fax:
Mailing address:
  • Phone: 310-279-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. EILEEN S KNOX
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-279-8606