Provider Demographics
NPI:1306092762
Name:ASANTE FAMILY AGENCY
Entity type:Organization
Organization Name:ASANTE FAMILY AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:UKIRU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-863-1186
Mailing Address - Street 1:2210 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4671
Mailing Address - Country:US
Mailing Address - Phone:909-863-1186
Mailing Address - Fax:909-863-1188
Practice Address - Street 1:2210 E HIGHLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4671
Practice Address - Country:US
Practice Address - Phone:909-863-1186
Practice Address - Fax:909-863-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS1467251B00000X, 251K00000X, 251X00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251X00000XAgenciesSupports Brokerage