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General NPI Number Information
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NPI Number | 1750147120
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Entity Type | Organization
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Legal Business Name | 2020 VISION YOUTH
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Dates
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Enumeration Date | 02/23/2024
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 12631 IMPERIAL HWY STE B103
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-6732
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Country | US
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Telephone | 213-691-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 967 KENDALL DR STE 332
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXCUTIVE OFFICER
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Name | CORY HOLLAMAN
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Credential |
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Telephone | 909-486-8690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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