=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881288215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FERREES GROUP HOME, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2021
-----------------------------------------------------
Last Update Date | 02/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 532 SANTA RITA PL
-----------------------------------------------------
City | BANNING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92220-1948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-797-3166
-----------------------------------------------------
Fax | 951-849-8516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 570
-----------------------------------------------------
City | CABAZON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92230-0570
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-797-3166
-----------------------------------------------------
Fax | 951-849-8516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ALISHA JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-322-5688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------