Provider Demographics
NPI:1295602704
Name:A COMING OF AGE FFA
Entity type:Organization
Organization Name:A COMING OF AGE FFA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PEER SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRAYLIN
Authorized Official - Middle Name:JERELL
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-723-0671
Mailing Address - Street 1:7899 MISSION GROVE PKWY S STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5062
Mailing Address - Country:US
Mailing Address - Phone:951-776-9223
Mailing Address - Fax:
Practice Address - Street 1:7899 MISSION GROVE PKWY S STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5062
Practice Address - Country:US
Practice Address - Phone:951-723-0671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty