Healthcare Provider Details

I. General information

NPI: 1912632951
Provider Name (Legal Business Name): SICKLE CELL DISEASE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 INLAND EMPIRE BLVD STE C315
ONTARIO CA
91764-4986
US

IV. Provider business mailing address

3602 INLAND EMPIRE BLVD STE C315
ONTARIO CA
91764-4986
US

V. Phone/Fax

Practice location:
  • Phone: 909-743-5226
  • Fax: 909-743-5227
Mailing address:
  • Phone: 909-743-5226
  • Fax: 909-743-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY WILLIAMS
Title or Position: SENIOR MANAGER
Credential:
Phone: 909-743-5226