=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154951200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELPING HEARTS CALIFORNIA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2020
-----------------------------------------------------
Last Update Date | 01/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11253 BLACKWOOD ST
-----------------------------------------------------
City | FONTANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92337-6831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-677-6644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 747 N EUCLID AVE
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91762-2711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-622-1290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | YNEZ C CROSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-622-1290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------