Provider Demographics
NPI:1386438893
Name:CALIFORNIA IMPACT COALITION FOUNDATION
Entity type:Organization
Organization Name:CALIFORNIA IMPACT COALITION FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANDAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-410-4371
Mailing Address - Street 1:3021 CITRUS CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2643
Mailing Address - Country:US
Mailing Address - Phone:925-433-2791
Mailing Address - Fax:925-433-2758
Practice Address - Street 1:2460 INCLINE CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8265
Practice Address - Country:US
Practice Address - Phone:925-433-2791
Practice Address - Fax:925-433-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency