PROMESA BEHAVIORAL HEALTH- MADERA NPI 1568957967

NPI Information

NPI: 1568957967
Provider Name: PROMESA BEHAVIORAL HEALTH- MADERA
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
10120 LANES BRIDGE DR
MADERA, CA
ZIP 93636
Phone: (559) 439-5437
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PROMESA BEHAVIORAL HEALTH- MADERA is a community based residential treatment facility mental illness in Madera, CA. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. PROMESA BEHAVIORAL HEALTH- MADERA NPI is 1568957967. The provider is registered as an organization entity type.

The provider's business location address is:

10120 LANES BRIDGE DR
MADERA, CA
ZIP 93636
Phone: (559) 439-5437

The provider's authorized official is Amanda Irene Reed .
The authorized official title is Director and has the following contact phone number (559) 439-5437.

The enumeration date for this NPI number is 6/27/2018 and was last updated on 8/13/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320800000X	Community Based Residential Treatment Facility, Mental Illness		200405478	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	101044	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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