Organization
CHCADA/ENHANCED SPECIALIZED FOSTER CARE MENTAL HLTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES HERNANDEZ (PROJECT DIRECTOR)
(916) 443-5473
Entity
Organization
Contact information
Practice address
9033 WASHINGTON BLVD, PICO RIVERA, CA 90660-3839
(562) 942-9625
(562) 942-9695
Mailing address
1419 21 STREET, SACRAMENTO, CA 95811
(916) 443-5473
(916) 443-1732
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7638
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
06/22/2007
Last updated
12/02/2015
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