Healthcare Provider Details

I. General information

NPI: 1700371572
Provider Name (Legal Business Name): ARK HOMES FOSTER FAMILY AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9645 ARROW ROUTE BLDG. 5, STE. A
RANCHO CUCAMONGA CA
91730-4554
US

IV. Provider business mailing address

9645 ARROW ROUTE BLDG. 5, STE. A
RANCHO CUCAMONGA CA
91730-4554
US

V. Phone/Fax

Practice location:
  • Phone: 909-948-5747
  • Fax:
Mailing address:
  • Phone: 909-948-5747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number366423827
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID KENNETH MATHIAS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MA
Phone: 909-948-5747