Healthcare Provider Details

I. General information

NPI: 1215840319
Provider Name (Legal Business Name): LIFECARE COALITION OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E ORANGEBURG AVE STE 14
MODESTO CA
95350-5340
US

IV. Provider business mailing address

121 E ORANGEBURG AVE STE 14
MODESTO CA
95350-5340
US

V. Phone/Fax

Practice location:
  • Phone: 209-408-8048
  • Fax: 209-336-6409
Mailing address:
  • Phone: 209-408-8048
  • Fax: 209-336-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: VICTORIA ANAGO
Title or Position: CEO
Credential:
Phone: 209-408-0326