Healthcare Provider Details

I. General information

NPI: 1811039597
Provider Name (Legal Business Name): HOMES OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S GLENDORA AVE
WEST COVINA CA
91790-4923
US

IV. Provider business mailing address

1107 S GLENDORA AVE
WEST COVINA CA
91790-4923
US

V. Phone/Fax

Practice location:
  • Phone: 626-814-9085
  • Fax: 626-960-9125
Mailing address:
  • Phone: 626-814-9085
  • Fax: 626-960-9125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. THERESA MCKINLEY
Title or Position: PROGRAM SUPERVISOR
Credential: LCSW
Phone: 626-814-9085