Individual
KELLY MARIE FOREMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 W HOSPITAL RD, FRENCH CAMP, CA 95231-9693
(209) 468-6013
(209) 468-7032
Mailing address
500 W HOSPITAL RD, FRENCH CAMP, CA 95231-9693
(209) 468-6013
(209) 468-7032
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
390002EN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B7155385
DMV
CA
Enumeration date
05/27/2019
Last updated
05/27/2019
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