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General NPI Number Information
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NPI Number | 1689475105
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Entity Type | Organization
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Legal Business Name | ERICA B INDEPENDENT LIVING FACILITY
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1779 E FLORIDA AVE STE B1
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City | HEMET
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State | CA
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Zip | 92544-4601
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Country | US
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Telephone | 818-818-1817
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 57
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City | PERRIS
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State | CA
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Zip | 92572-0057
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Country | US
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Telephone | 951-226-1750
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Fax | 951-200-4761
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Authorized Official
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Title or Position | OWNER
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Name | ERICA GRAHAM- BULLOCK
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Credential |
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Telephone | 818-818-1817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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