Provider Demographics
NPI:1811533052
Name:GARCIA, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HERITAGE GROUP HOMES INC
Mailing Address - Street 2:158 GENTRY STREET
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768
Mailing Address - Country:US
Mailing Address - Phone:909-599-8222
Mailing Address - Fax:909-599-8223
Practice Address - Street 1:30 COUNTRY WOOD DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-4818
Practice Address - Country:US
Practice Address - Phone:909-623-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF7273627101YM0800X
CAASW91504104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health