Erica Rene Graham-Bullock
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Perris, CA. Individual provider (NPI-1).
NPI number1063284875
StatusActive
Last updated in NPPESOct 25, 2023
Details
- NPI
- 1063284875
- Entity type
- Individual (NPI-1)
- Name
- Erica Rene Graham-Bullock
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 25, 2023
- Certification date
- Oct 25, 2023
- Last updated
- Oct 25, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | 331881331 | CA | Yes |
Other names
- Erica Rene Graham-Bullock (Other Name)
Practice location
3656 Ginger StPerris, CA 92571-7825
Phone 818-818-1817
Mailing address
3656 Ginger StPerris, CA 92571-7825
Phone 818-818-1817
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