Healthcare Provider Details

I. General information

NPI: 1104759422
Provider Name (Legal Business Name): THE MAKADE FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19429 FORTUNELLO AVE
RIVERSIDE CA
92508-6140
US

IV. Provider business mailing address

231 E ALESSANDRO BLVD STE A301
RIVERSIDE CA
92508-5084
US

V. Phone/Fax

Practice location:
  • Phone: 951-201-1908
  • Fax:
Mailing address:
  • Phone: 951-201-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JORGE CERVANTES
Title or Position: CEO
Credential:
Phone: 951-201-1908