Healthcare Provider Details

I. General information

NPI: 1467778050
Provider Name (Legal Business Name): ASANTE FAMILY AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 E HIGHLAND AVE STE 107
SAN BERNARDINO CA
92404-4652
US

IV. Provider business mailing address

1255 E HIGHLAND AVE STE 107
SAN BERNARDINO CA
92404-4652
US

V. Phone/Fax

Practice location:
  • Phone: 909-383-3332
  • Fax:
Mailing address:
  • Phone: 909-383-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA UKIRU
Title or Position: DIRECTOR
Credential: MPH, MSW
Phone: 909-383-3322