1700371572 NPI number — ARK HOMES FOSTER FAMILY AGENCY

Table of content: (NPI 1700371572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700371572 NPI number — ARK HOMES FOSTER FAMILY AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARK HOMES FOSTER FAMILY AGENCY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700371572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9645 ARROW ROUTE
Provider Second Line Business Mailing Address:
BLDG. 5, STE. A
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-4554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-948-5747
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9631 BUSINESS CENTER DRIVE
Provider Second Line Business Practice Location Address:
BLDG. 14, STE. D
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-4545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-948-5747
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MATHIAS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
909-948-5747

Provider Taxonomy Codes

  • Taxonomy code: 253J00000X , with the licence number:  366423827 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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