Provider Demographics
NPI:1689475105
Name:ERICA B INDEPENDENT LIVING FACILITY
Entity type:Organization
Organization Name:ERICA B INDEPENDENT LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM- BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-818-1817
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92572-0057
Mailing Address - Country:US
Mailing Address - Phone:951-226-1750
Mailing Address - Fax:951-200-4761
Practice Address - Street 1:1779 E FLORIDA AVE STE B1
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4601
Practice Address - Country:US
Practice Address - Phone:818-818-1817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities