Healthcare Provider Details

I. General information

NPI: 1598581985
Provider Name (Legal Business Name): OVERCOMERS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4051 PINE LAKE CIR
STOCKTON CA
95219-2018
US

IV. Provider business mailing address

4051 PINE LAKE CIR
STOCKTON CA
95219-2018
US

V. Phone/Fax

Practice location:
  • Phone: 760-217-5286
  • Fax:
Mailing address:
  • Phone: 760-217-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CHRISTINA PERAZA
Title or Position: CEO
Credential:
Phone: 760-217-5286