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General NPI Number Information
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NPI Number | 1295602704
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Entity Type | Organization
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Legal Business Name | A COMING OF AGE FFA
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 7899 MISSION GROVE PKWY S STE A
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City | RIVERSIDE
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State | CA
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Zip | 92508-5062
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Country | US
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Telephone | 951-723-0671
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Fax |
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Provider Business Mailing Address
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Address Line | 7899 MISSION GROVE PKWY S STE A
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City | RIVERSIDE
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State | CA
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Zip | 92508-5062
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Country | US
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Telephone | 951-776-9223
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Fax |
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Authorized Official
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Title or Position | CERTIFIED PEER SUPPORT SPECIALIST
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Name | BRAYLIN JERELL DODSON
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Credential |
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Telephone | 951-723-0671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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