NPIMap

Organization Active NPI

Erica B Independent Living Facility

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Perris, CA
National Provider Identifier
1780434829
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
ERICA B INDEPENDENT LIVING FACILITY
Practice address
3656 Ginger St
Perris, CA 92571-7825
Phone
(951) 226-1750
Fax
(951) 200-4761
NPI assigned
Mar 22, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Authorized official

Name
Erica Rene Graham-BullockNPI 1063284875
Title
Owner- Administrator
Phone
(951) 226-1750

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Primary

Addresses

Primary practice location

3656 Ginger St
Perris, CA 92571-7825

Mailing address

3656 Ginger St
Perris, CA 92571-7825
Phone (951) 226-1750

Other names 1

  • ERICA B INDEPENDENT LIVING FACILITY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Erica B Day Habilitation Programs2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1780434829",
    "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": "951-226-1750",
            "fax_number": "951-200-4761"
        },
        {
            "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": "951-226-1750",
            "fax_number": "951-200-4761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICA B INDEPENDENT LIVING FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "GRAHAM-BULLOCK",
        "authorized_official_first_name": "ERICA",
        "authorized_official_middle_name": "RENE",
        "authorized_official_title_or_position": "OWNER- ADMINISTRATOR",
        "authorized_official_telephone_number": "951-226-1750"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ERICA B INDEPENDENT LIVING FACILITY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Perris, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.