Healthcare Provider Details

I. General information

NPI: 1013508969
Provider Name (Legal Business Name): WOMEN ACHIEVING SUCCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N A ST
PERRIS CA
92570-1911
US

IV. Provider business mailing address

75 W NUEVO RD STE E
PERRIS CA
92571-0801
US

V. Phone/Fax

Practice location:
  • Phone: 855-978-3278
  • Fax: 800-317-1490
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KATIE MARIE MCCLENDON
Title or Position: CEO
Credential:
Phone: 855-978-3278