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General NPI Number Information
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NPI Number | 1700371572
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Entity Type | Organization
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Legal Business Name | ARK HOMES FOSTER FAMILY AGENCY
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 9645 ARROW ROUTE BLDG. 5, STE. A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4554
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Country | US
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Telephone | 909-948-5747
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Fax |
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Provider Business Mailing Address
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Address Line | 9645 ARROW ROUTE BLDG. 5, STE. A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-4554
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Country | US
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Telephone | 909-948-5747
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. DAVID KENNETH MATHIAS
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Credential | MA
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Telephone | 909-948-5747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 366423827
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License Number State | CA
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