Healthcare Provider Details

I. General information

NPI: 1124999214
Provider Name (Legal Business Name): MELANIN YOUTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21550 LANE ST
PERRIS CA
92570-8140
US

IV. Provider business mailing address

19510 VAN BUREN BLVD. STE F3 PMB 152
RIVERSIDE CA
92508-9458
US

V. Phone/Fax

Practice location:
  • Phone: 951-712-5031
  • Fax:
Mailing address:
  • Phone: 951-712-5031
  • 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 TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL MELESSIA SINGH
Title or Position: PRESIDENT
Credential:
Phone: 951-712-5031