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General NPI Number Information
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NPI Number | 1386438893
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Entity Type | Organization
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Legal Business Name | CALIFORNIA IMPACT COALITION FOUNDATION
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 2460 INCLINE CT
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City | ANTIOCH
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State | CA
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Zip | 94531-8265
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Country | US
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Telephone | 925-433-2791
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Fax | 925-433-2758
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Provider Business Mailing Address
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Address Line | 3021 CITRUS CIR STE 110
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City | WALNUT CREEK
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State | CA
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Zip | 94598-2643
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Country | US
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Telephone | 925-433-2791
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Fax | 925-433-2758
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | MR. MANDAVE SANDHU
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Credential |
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Telephone | 510-410-4371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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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