=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639049455
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INNER CIRCLE FOSTER FAMILY AGENCY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2025
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3903 TYLER AVE
-----------------------------------------------------
City | EL MONTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91731-2037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-988-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3903 TYLER AVE
-----------------------------------------------------
City | EL MONTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91731-2037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-988-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | SANDRO VILLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-819-8477
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------