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General NPI Number Information
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NPI Number | 1104382183
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Entity Type | Organization
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Legal Business Name | KAMALI'I FOSTER FAMILY AGENCY, INC.
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 31772 CASINO DR STE B
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-4502
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Country | US
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Telephone | 951-674-9400
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Fax | 951-674-9486
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Provider Business Mailing Address
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Address Line | 31772 CASINO DR STE B
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-4502
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Country | US
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Telephone | 951-674-9400
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Fax | 951-674-9486
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Authorized Official
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Title or Position | CEO/PROGRAM DIRECTOR
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Name | JOHN ERIC MORTENSEN
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Credential | M.S.
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Telephone | 951-674-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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