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WELL OF HEALING MOBILE MEDICAL CLINIC
NPI 1619195740
Community/Behavioral Health in Fontana, CA

Active since April 23, 2007CLIA 05D1047724 · Waiver
7623 EAST AVE, FONTANA, CA 92336(909) 463-0103(909) 463-4840 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Well Of Healing Mobile Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WELL OF HEALING MOBILE MEDICAL CLINIC (NPI 1619195740) is a healthcare organization registered as a community/behavioral health in Fontana, California and active in the NPI registry since April 2007. The organization holds a CLIA Waiver certificate valid through January 8, 2027 and lists Angela Coaston, Administrator, as its authorized official.

NPPES Registry Identity

NPI1619195740
Entity TypeOrganization
Primary Taxonomy251S00000X
Legal Business NameWATER OF LIFE COMMUNITY OUTREACH
Location Address7623 EAST AVEFontana, CA 92336-2901
Mailing Address7623 East AveFontana, CA 92336-2901 · (909) 463-0103 · Fax (909) 463-4840
Phone(909) 463-0103
Fax(909) 463-4840
Organization SubpartNo
Authorized OfficialAngela CoastonAdministrator · (909) 463-0103
Enumeration DateApril 23, 2007
Last NPPES UpdateJuly 21, 2022
✔ NPI 1619195740 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity/Behavioral HealthAgencies
Taxonomy Code251S00000X
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
7623 EAST AVE, Fontana, CA 92336
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Other Names 1

Doing Business AsWell Of Healing Mobile Medical Clinic

Other Identifiers 1

MedicaidCMM71071FCA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D1047724

Well Of Healing Mobile Medical Clinic At Water Of Life Community Church · Fontana, CA
Active · expires Jan 8, 2027
CLIA Number05D1047724
Laboratory TypeMobile Med Clinic
Certificate Effective DateJanuary 9, 2025
Certificate Expiration DateJanuary 8, 2027
Laboratory DirectorDr. Edgar Ochoa
Laboratory Phone(909) 268-1086
Laboratory LocationWell Of Healing Mobile Medical Clinic At Water Of Life Community Church7623 East Ave, Fontana, CA 92336
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Water Of Life Community Outreach's NPI number?

The NPI number for Water Of Life Community Outreach is 1619195740. It was assigned to this organization in the NPPES registry on April 23, 2007. The provider is doing business as Well Of Healing Mobile Medical Clinic.

Where is Water Of Life Community Outreach located?

Water Of Life Community Outreach is located at 7623 East Ave, Fontana, CA 92336. The listed phone number is (909) 463-0103.

What is Water Of Life Community Outreach's specialty?

The primary specialty registered for this NPI is Community/Behavioral Health with taxonomy code 251S00000X.

Does Water Of Life Community Outreach hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D1047724) is associated with this NPI, valid through January 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Water Of Life Community Outreach was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.