Healthcare Provider Details

I. General information

NPI: 1609414739
Provider Name (Legal Business Name): WEST COVINA FOSTER FAMILY AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1568 MCLEOD PL
POMONA CA
91768-1348
US

IV. Provider business mailing address

527 E ROWLAND ST STE 100C&D
COVINA CA
91723-3266
US

V. Phone/Fax

Practice location:
  • Phone: 909-620-7543
  • Fax: 909-865-3325
Mailing address:
  • Phone: 626-814-9085
  • Fax: 626-814-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SUKHWINDER KAUR SINGH
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 626-814-9085