Water of Life Community Outreach

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

WATER OF LIFE COMMUNITY OUTREACH

Doing business as

Well of Healing Mobile Medical Clinic

Practice address

7623 East Ave
Fontana, CA 92336-2901

Phone

(909) 463-0103

Fax

(909) 463-4840

NPI assigned

Apr 23, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Angela Coaston, R.N.

Title

Administrator

Phone

(909) 463-0103

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Well of Healing Mobile Medical Clinic Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1619195740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7623 EAST AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923362901",
            "telephone_number": "909-463-0103",
            "fax_number": "909-463-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7623 EAST AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923362901",
            "telephone_number": "909-463-0103",
            "fax_number": "909-463-4840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATER OF LIFE COMMUNITY OUTREACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "COASTON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "909-463-0103",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM71071F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Well of Healing Mobile Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Renee Nicole Warner, RD
• Andrew Kyung Warnock, PHARM.D.
• Rawlin L Warta, PA
• Andra Amory Wasket
• Water of Life Community Church
• Way for U Logistics LLC
• Henry B. Waydeman, MD
• Monica Yvonne Wayne
• William A Webb, PA
• Jasmine Weber

• Community/Behavioral Health Agency in Fontana, CA
• Providers in Fontana, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.