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General NPI Number Information
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NPI Number | 1104759422
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Entity Type | Organization
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Legal Business Name | THE MAKADE FOUNDATION INC
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 19429 FORTUNELLO AVE
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City | RIVERSIDE
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State | CA
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Zip | 92508-6140
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Country | US
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Telephone | 951-201-1908
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Fax |
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Provider Business Mailing Address
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Address Line | 231 E ALESSANDRO BLVD STE A301
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City | RIVERSIDE
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State | CA
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Zip | 92508-5084
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Country | US
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Telephone | 951-201-1908
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JORGE CERVANTES
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Credential |
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Telephone | 951-201-1908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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