Healthcare Provider Details

I. General information

NPI: 1497634976
Provider Name (Legal Business Name): FORMERLY INCARCERATED STRIVING AND THRIVING AND THE STRIVE THRIVE AND RISE GENERATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 W CHAPEL ST
SANTA MARIA CA
93458-4312
US

IV. Provider business mailing address

212 SARATOGA CT
GOLETA CA
93117-2405
US

V. Phone/Fax

Practice location:
  • Phone: 805-319-9159
  • Fax: 805-259-4090
Mailing address:
  • Phone: 805-319-9159
  • Fax: 805-259-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GABRIEL ANTHONY OCHOA
Title or Position: CHAIRPERSON
Credential:
Phone: 805-319-9159