MEDICARE: THE MAKADE FOUNDATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1407702053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MAKADE FOUNDATION INC

Provider Business Mailing Address
First Line	:	3020 MANCHESTER CIR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-6127
Country	:	US
Telephone Number	:	562-200-6670
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 MANCHESTER CIR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-6127
Country	:	US
Telephone Number	:	951-256-1976
Fax Number	:

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	LAURA HARTNEY
Credential	:
Telephone Number	:	951-731-2155

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	05/26/2026

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Directions to “THE MAKADE FOUNDATION INC ” Practice Location

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