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Organization
2020 VISION YOUTH
Active
Organization
2020 VISION YOUTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORY HOLLAMAN (CHIEF EXCUTIVE OFFICER)
(909) 486-8690
Entity
Organization
Contact information
Practice address
14241 FIRESTONE BLVD STE 225, LA MIRADA, CA 90638-5533
(213) 691-2522
Mailing address
967 KENDALL DR STE 332, SAN BERNARDINO, CA 92407-4306
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
171400000X
Health & Wellness Coach
Primary
—
NULL
171400000X
Health & Wellness Coach
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
NULL
172V00000X
Community Health Worker
—
—
Other
Enumeration date
02/23/2024
Last updated
02/28/2026
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