Healthcare Provider Details

I. General information

NPI: 1588780811
Provider Name (Legal Business Name): VOLUNTEERS OF AMERICA SOUTHWEST CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 HARRISON ST
RIVERSIDE CA
92503-4289
US

IV. Provider business mailing address

3530 CAMINO DEL RIO N STE 300
SAN DIEGO CA
92108-1746
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-7701
  • Fax:
Mailing address:
  • Phone: 619-228-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIE MCKENZIE
Title or Position: EXECUTIVE VICE PRESIDENT/COO
Credential:
Phone: 619-228-2057