Erica Rene Graham-Bullock

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

331881331 Issued in CA

Practice address

3656 Ginger St
Perris, CA 92571-7825

Phone

(818) 818-1817

NPI assigned

Oct 25, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Erica Rene Graham-Bullock Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Erica B a Eva Girl for the Cause Sober Living

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Hemet, CA
  • NPI 1528853421
  NPD Authorized official
• Erica B Independent Living Facility

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Hemet, CA
  • NPI 1689475105
  NPD Authorized official
• Erica B Independent Living Facility

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Perris, CA
  • NPI 1780434829

  Residential Treatment Facility, Intellectual and/Or Developmental Disabilities

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1063284875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3656 GINGER ST",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925717825",
            "telephone_number": "818-818-1817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3656 GINGER ST",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925717825",
            "telephone_number": "818-818-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM-BULLOCK",
        "first_name": "ERICA",
        "middle_name": "RENE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-25",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": "331881331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERICA",
            "last_name": "GRAHAM-BULLOCK",
            "middle_name": "RENE",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Audrianna Gonzlaes- Ortiz
• Laura Estefania Gordillo
• Lauren Kathleen Gorzo
• Aime Govea, LMFT
• Aaron Graddy
• Alonza C Graham
• Cherie Pena Grajeda
• Shannon Demetris Gray
• Greatest Balance Residential Care
• Heidi Marie Green

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Perris, CA
• Providers in Perris, CA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.